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Medicare, managed care, and cancer
1Health Care Financing Administration, Baltimore, Maryland, USA.
Oncology (Williston Park, N.Y.)
|June 17, 1999
Summary
Medicare managed care is evolving, necessitating diverse delivery systems and improved payments for sicker beneficiaries. Enhanced beneficiary information is crucial for quality-based plan selection beyond cost.
Area of Science:
- Health Policy
- Healthcare Management
- Medicare Program Analysis
Background:
- The Medicare program has experienced significant transformations over the past decade, largely driven by the expansion of Medicare managed care.
- Ongoing changes are anticipated due to the Health Care Financing Administration's implementation of the Balanced Budget Act of 1997.
Purpose of the Study:
- To advocate for Medicare's openness to diverse healthcare delivery systems beyond traditional health maintenance organizations.
- To recommend improvements in payment structures to support organizations enrolling and treating sicker Medicare beneficiaries.
- To emphasize the need for comprehensive beneficiary information to facilitate quality-based plan selection.
Main Methods:
- Policy analysis of Medicare program changes.
- Review of managed care growth within Medicare.
- Examination of the Balanced Budget Act of 1997 implications.
Main Results:
- The Medicare program requires adaptation to new delivery models.
- Current payment mechanisms may not adequately support the enrollment and care of sicker populations.
- Beneficiary decision-making is often cost-driven rather than quality-driven.
Conclusions:
- Medicare should embrace a wider array of organized delivery systems.
- Payment reforms are essential to incentivize the enrollment and management of complex patient populations.
- Empowering beneficiaries with quality-focused data is critical for informed Medicare plan choices.