The future of Medicare and managed care: implications for optometry

Medicare, the major health entitlement program for the elderly, is faced with many challenges. Health costs and managed care have been instrumental in restructuring delivery of health care in this country. The Medicare program, the last bastion of unmanaged and fee-for-service care, is now under pressure to conform to the changes already embraced within the private sector.

Data obtained from the Health Care Finance Administration (HCFA) demonstrate how marketing strategies and enrollment programs are successful in enrolling Medicare beneficiaries into health maintenance organizations (HMOs). Enrollment in Medicare risk-contract HMOs has doubled in the last 2 years as HMOs actively market the Medicare population. New managed care options are being developed for Medicare patients.

HMOs are marketing their plans specifically toward Medicare beneficiaries and are offering increased benefits-including vision care-to encourage increased enrollment. Optometric participation in the Medicare program will be affected Freedom of choice will be restricted to panel practitioners who participate with these HMOs. Practitioners will be subject to credentialing criteria established by the HMOs, site visitations, audits, and other aspects of quality assurance implemented by the HMOs.