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Medicare increases managed care's accountability, Part 1

¹Birch & Davis Health Management Corp., Silver Spring, Md., USA.

Nursing Management

|February 13, 1999

Summary

Medicare

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Area of Science:

Healthcare Administration
Quality Improvement
Managed Care Policy

Background:

The initiation of Medicare's Quality Improvement System for Managed Care (QISMC).
QISMC mandates health plans to show enhanced quality of care for members.

Purpose of the Study:

To analyze the impact of QISMC implementation on managed health plans.
To assess the financial implications for health plans under the new QISMC regulations.

Main Methods:

Qualitative analysis of QISMC requirements.
Economic assessment of administrative cost changes.

Main Results:

QISMC implementation is projected to raise administrative costs for health plans.
Capitation rates are not expected to increase concurrently with rising costs.

Conclusions:

Managed care organizations face increased operational expenses due to QISMC.
The financial viability of health plans may be challenged by the disparity between rising costs and fixed reimbursement rates.

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