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How ready are health plans for Medicare?

作者信息

Gaumer G, Moore T, Friedman M, Bix B

机构信息

Health Care Associates Plus, Cambridge, MA, USA.

出版信息

Eff Clin Pract. 1999 Jan-Feb;2(1):11-6.

PMID:10346548
Abstract

CONTEXT

The Medicare program is encouraging its beneficiaries to enroll in capitated health plans.

OBJECTIVE

To determine how prepared these plans are to handle chronically ill and frail elderly persons.

DESIGN

Telephone survey of 28 health plans that together serve about one fourth of all enrollees of the Medicare Risk program.

MEASURES

The degree of readiness (high, intermediate, or low) of health plans in seven domains that experts believe are important to the management of an elderly population.

RESULTS

None of the 28 health plans had high readiness scores for all seven domains. The two domains for which the plans were most prepared were risk assessment and member self-care. The plans were least prepared for the domains of cooperative team care and geriatric consultations.

CONCLUSIONS

Many plans do not offer the programs that experts believe are important for Medicare enrollees. They may hesitate to adopt strategies that lack data on effectiveness.

摘要

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