Purchasing Health Care Services in a Competitive Environment: Hearing Before the Committee on Finance, United States Senate, One Hundred Eighth Congress, First Session, April 3, 2003

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U.S. Government Printing Office, 2003 - 157 pages

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Page 135 - Alcohol and Other Drug Treatment for Parents and Welfare Recipients: Outcomes, Costs, and Benefits.
Page 48 - There is an opportunity to enroll in the program, change health plans, or change enrollment status at least once a year during the 4-week annual open season that begins in November.
Page 121 - No longer will older Americans be denied the healing miracle of modern medicine. No longer will illness crush and destroy the savings that they have so carefully put away over a lifetime so that they might enjoy dignity in their later years. No longer will young families see their own incomes, and their own hopes, eaten away simply because they are carrying out their deep moral...
Page 150 - ... premium increase in 2003. Keep In mind that the average age of the FEHBP population is about 47 years of age, while that of traditional older Medicare population is about 70. Medicare beneficiaries have more chronic conditions, requiring greater drug use, which results in higher per capita expenditures than the much-younger, healthier FEHBP population. If the PBMs have not been able to manage prescription drug spending in the FEHBP program's younger, healthier population, why should we believe...
Page 5 - Unlike the 1980's when we were flooded with applications in the current market, we average about six new plans a year. Rates are negotiated with the national plans based primarily on their claims experience. About 93 percent of premium, or 93 cents out of every dollar, reflects benefit costs. The remaining 7 percent covers the plans
Page 124 - ... there are adverse outcomes. For instance, we have found that as the number of chronic conditions increase, so too do the number of inappropriate hospitalizations for illnesses that could have received effective outpatient treatment (Ambulatory Care Sensitive Conditions). Per 1,000 beneficiaries, these hospitalizations increase from seven for people with one chronic condition to 95 for beneficiaries with five chronic conditions, and jumps again to 261 for people with 10 or more chronic conditions.3...
Page 129 - ... for payment. Nonavailability statements are not required for emergency care or outpatient care regardless of whether the beneficiaries reside within 40 miles of uniformed services hospitals. SCOPE OF REVIEW We made our review at the Offices of the Assistant Secretary of Defense (Health Affairs) and the Surgeons General of the Army, Navy, and Air Force and the headquarters of the Public Health Service in Washington, DC To assess the effect of the 40-mile rule, we also reviewed records and held...
Page 130 - ... While we are proud of our accomplishments in TRICARE, we also recognized that improvements can be made in the administration of this program. This year is an important transition year for TRICARE and we have begun the transition process already. New TRICARE Contracts hi August 2002, we issued Requests for Proposal for a new generation of TRICARE contracts - simpler, more customer-focused, easier to administer, and with greater local accountability for performance. We reduced the number of TRICARE...
Page 130 - ... Proposal for a new generation of TRICARE contracts - simpler, more customer-focused, easier to administer, and with greater local accountability for performance. We reduced the number of TRICARE regional contracts from seven to three, and we reduced the number of TRICARE regions from eleven to three. The contracts include incentives for contractors to utilize local military medical facilities, and to increase patient satisfaction. We are aligning our incentive structure so that Service medical...
Page 49 - ... Underserved Areas" that ensures that Members have access to health care providers. Our fee-for-service plans must pay for covered services provided by any licensed provider practicing within the scope of his or her license, even if that provider is not considered a covered plan provider. Conclusion The FEHB Program uses a hybrid approach that shares practices with both public sector and private employer health insurance programs. While we believe the program has been very successful over its...

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