The Surge in Medicare Managed Care: An Update

Health Affairs

Volumn 16, Issue 3, 1997, Pages 127-133

  Lamphere, Jo Ann ^a   Neuman, Patricia ^b   Langwell, Kathryn ^c   Sherman, Daniel ^c  

^a KPMG LLP   (United States)

^b HENRY J KAISER FAMILY FOUNDATION   (United States)

^c NONE

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; HEALTH MAINTENANCE ORGANIZATION; HUMAN; MEDICARE; ORGANIZATION AND MANAGEMENT; RISK; UNITED STATES;

HEALTH MAINTENANCE ORGANIZATIONS; HUMANS; MEDICARE; RISK; UNITED STATES;

EID: 0344855895     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.16.3.127     Document Type: Review

References (14)

1. Congressional Budget Office, "Managed Care and Medicare," CBO memorandum, 26 April 1995.
2. President Clinton's fiscal year 1998 budget.
3. Congressional Budget Office, 1 January 1997.
4. CBO, "Managed Care and Medicare."
5. Foster Higgins, "National Survey of Employer-Sponsored Health Plans, 1996" (New York: Foster Higgins, February 1997).
6. State enrollment data are organized according to the state in which the plan is based. While this analysis would tabulate a state's enrollment as zero if the state had no Medicare risk plan, in reality. Medicare beneficiaries may be enrolled through a plan in another state.
7. Alaska, Delaware, Idaho, Iowa, Maine, Mississippi, Montana, New Hampshire, North Dakota, South Dakota, Vermont, West Virginia, and Wyoming.
8. A.H. McCloskey et al., Reforming the Health Care System: State Profiles, 1996 (Washington: American Association of Retired Persons, 1996).
9. Frederick Schneiders, Inc., "Analysis of Focus Groups concerning Managed Care and Medicare," Report prepared for The Henry J. Kaiser Family Foundation, March 1995.
10. The adjusted community rate is an estimate used by the Health Care Financing Administration (HCFA) to recapture any excess savings that plans gain under AAPCC rates. The estimate is based on a comparison of projected Medicare revenue with the amount of revenue that the plan would receive for Medicare enrollees under commercial rates.
11. Health Care Financing Administration, "Monthly Report of Medicare Prepaid Health Plans," December 1994 and December 1996.
12. Early studies of the Medicare HMO program indicated that the AAPCC payment level had a significant effect on HMO market entry. K.W. Adamache and L. Rossiter, "The Entry of HMOs into the Medicare Market: Implications for TEFRA's Mandate," Inquiry (Winter 1986); and K. Langwell et al., First Annual Report: National Evaluation of Medicare Competition Demonstrations, Report prepared for the Health Care Financing Administration (Washington: Mathematica Policy Research, Inc., November 1985). The impact of Medicare payment rates on the current risk-contract program is being studied by the Kaiser Family Foundation through a grant to the Barents Group.
13. Early studies of the Medicare HMO program indicated that the AAPCC payment level had a significant effect on HMO market entry. K.W. Adamache and L. Rossiter, "The Entry of HMOs into the Medicare Market: Implications for TEFRA's Mandate," Inquiry (Winter 1986); and K. Langwell et al., First Annual Report: National Evaluation of Medicare Competition Demonstrations, Report prepared for the Health Care Financing Administration (Washington: Mathematica Policy Research, Inc., November 1985). The impact of Medicare payment rates on the current risk-contract program is being studied by the Kaiser Family Foundation through a grant to the Barents Group.
14. W.P. Welch, "Growth in HMO Share of the Medicare Market, 1989-1994," Health Affairs (Fall 1996): 201-214.