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Related Experiment Videos

Medicare+Choice: doubling or disappearing?

Robert A Berenson1

  • 1Academy for Health Services Research and Health Policy, USA.

Health Affairs (Project Hope)
|March 26, 2002
PubMed
Summary
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Health plans face challenges beyond Medicare+Choice (M+C) reforms. Redesigning Medicare managed care payments and focusing on value-based purchasing for chronic disease care are proposed solutions.

Area of Science:

  • Health Policy
  • Managed Care Economics
  • Medicare Program Analysis

Background:

  • The Medicare+Choice (M+C) program faces instability, often attributed to the Balanced Budget Act.
  • Health plans exhibit market-wide difficulties, not solely within Medicare.

Purpose of the Study:

  • To analyze the root causes of Medicare+Choice program instability.
  • To propose fundamental redesigns for Medicare managed care payment structures.

Main Methods:

  • Qualitative analysis of health plan market performance.
  • Review of existing Medicare payment models for managed care organizations.
  • Proposal of alternative payment strategies.

Main Results:

  • Instability in Medicare+Choice is not exclusively due to legislative changes.

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  • Health plans experience challenges across diverse markets.
  • Current payment mechanisms may require reevaluation.

    • Conclusions:

    • Reconsideration of the Medicare+Choice program's objectives is warranted.
    • Fundamental redesign of payment to managed care organizations is suggested.
    • Alternative approaches include decoupling payments from traditional Medicare spending and implementing value-based purchasing for chronic disease care.