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- W2009209051 abstract "Prologue: When auditors for the Department of Health and Human Services announced recently that the Medicare program had overpaid an estimated $23 billion in 1996, many observers were outraged, but few were surprised. The program's financial and management woes, including the problem of fraudulent claims, were not a new concern. Congressional reformers were already looking for ways to cut $115 billion from the program's projected costs over the next five years; doctors, hospitals, and managed care plans were already bracing themselves for reductions in Medicare payments; and the program's administrators were already seeking to run a tighter ship despite the bureaucratic obstacles they face as a public agency. One of the many questions ahead for the Medicare program is how to streamline its fee-for-service program while continuing to encourage enrollment in Medicare health maintenance organizations. Analysts expect that the traditional program will continue to represent the majority of the Medicare population. In this paper, Peter Fox, an independent managed care consultant based in Chevy Chase, Maryland, and former vice-president of The Lewin Group, suggests that the celebrated efficiencies of managed care are not beyond the reach of the traditional Medicare program. Fox was once a Health Care Financing Administration official himself, and his paper reflects his understanding of both the organizational barriers and the opportunities involved in adapting managed care techniques to the fee-for-service sector. ABSTRACT: Medicare has lagged behind the private sector in its reliance on managed care, which, properly done, has the potential to restrain budget growth and enhance quality. This paper addresses how the Medicare fee-for-service program—traditional Medicare—might apply managed care techniques. It first discusses the institutional constraints Medicare faces in implementing managed care techniques and then presents options for applying these techniques. I propose elements of an overall strategy to incorporate managed care in the fee-for-service program." @default.
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- W2009209051 title "Applying Managed Care Techniques In Traditional Medicare" @default.
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- W2009209051 doi "https://doi.org/10.1377/hlthaff.16.5.44" @default.
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