Shifting the Paradigm: Monitoring Access in Medicare Managed Care
نویسندگان
چکیده
Medicare managed care enrollment growth points to the need to develop an approach for monitoring access to care for the increasing number of beneficiaries who use these arrangements. This article describes the issues to be addressed in designing a system for monitoring managed care plan enrollees' ability to obtain needed medical care on a timely basis. We review components of the monitoring approach used for traditional fee-for-service (FFS) Medicare, including the conceptual framework, data, measures, and subgroups targeted in monitoring efforts, and discuss the adaptation of that approach for monitoring access in Medicare managed care.
منابع مشابه
Monitoring and Evaluating the Delivery of Services Under Managed Care
This overview discusses the importance of monitoring and evaluating the delivery of services under managed care, particularly with respect to assessing access and quality in managed care. It also lists recent Health Care Financing Administration (HCFA) initiatives in this area, and presents an introduction to the articles published in this issue of the Review. The topics addressed by these arti...
متن کاملMeasuring Up: A Novel Approach to Assessing State Oversight of Medicaid Managed Care
States that contract with managed care plans must demonstrate to a variety of stakeholders, including the Centers for Medicare & Medicaid Services (CMS), that the state Medicaid agency is appropriately overseeing the plans. This includes monitoring enrollees’ access to care as well as the quality and cost of services. However, there are no recognized standards for what constitutes sufficient mo...
متن کاملMedicare Advantage? The Effects of Managed Care on Quality of Care
Recent policy reforms have sought to expand the role of managed care in Medicare, despite limited information about quality of care provided by Medicare managed care (MMC) plans. This paper uses a unique inpatient hospitalization dataset containing over 9 million records to analyze outpatient quality and access to care in MMC in four states from 1999 2004. Several econometric strategies are use...
متن کاملAccess is better for racial/ethnic elderly in Medicare HMOs--but disparities persist.
Managed care has grown dramatically over the years, first among private employers, then in Medicaid programs (Medi-Cal in California) and in the Medicare system. Today, two in five older persons in California (40%) are in Medicare HMOs at any one time. Nationwide, one in six (17%) among the elderly population is in a Medicare HMO. This Policy Brief reports new findings on access to care of elde...
متن کاملMedicare Part D-a roundtable discussion of current issues and trends.
BACKGROUND Medicare Part D was introduced with a goal of providing access to prescription drug coverage for all Medicare beneficiaries. Regulatory mandates and the changing landscape of health care require continued evaluation of the state of the Part D benefit. OBJECTIVE To review the current state of plan offerings and highlight key issues regarding the administration of the Part D benefit....
متن کامل