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, 2003U.S. Government Printing Office, 2003 - 157 pages |
From inside the book
Results 1-5 of 34
Page 3
... rate , increased enrollment in PPOs certainly will not improve Medicare's solvency . This leads to my last questions . Are these competitive systems truly transferrable to Medicare , and to what degree , to what degree not ? Perhaps ...
... rate , increased enrollment in PPOs certainly will not improve Medicare's solvency . This leads to my last questions . Are these competitive systems truly transferrable to Medicare , and to what degree , to what degree not ? Perhaps ...
Page 5
... rates are negotiated annually , OPM does not issue a request for bids . Instead , we issue a call letter to partici- pating carriers in the spring that provides them guidance for the upcoming negotiations . Plans remain in the program ...
... rates are negotiated annually , OPM does not issue a request for bids . Instead , we issue a call letter to partici- pating carriers in the spring that provides them guidance for the upcoming negotiations . Plans remain in the program ...
Page 6
... Rates are negotiated with the national plans based primarily on their claims experience . About 93 percent of ... rate negotiations are based on a per- member , per - month community rate . Adjustments may be nego- tiated to the base ...
... Rates are negotiated with the national plans based primarily on their claims experience . About 93 percent of ... rate negotiations are based on a per- member , per - month community rate . Adjustments may be nego- tiated to the base ...
Page 15
... rate increase our actuaries are now able to estimate that the potential rate increase in any given year , on average , is reduced by about 1 percent every year as a result of people moving to lower cost plans . Senator THOMAS ...
... rate increase our actuaries are now able to estimate that the potential rate increase in any given year , on average , is reduced by about 1 percent every year as a result of people moving to lower cost plans . Senator THOMAS ...
Page 16
... rate negotia- tion process just like OPM and others do , with a real focus during that process of understanding ... rates with hospitals and doctors . The sec- ond , is we invest in technology and better ways of working so that our ...
... rate negotia- tion process just like OPM and others do , with a real focus during that process of understanding ... rates with hospitals and doctors . The sec- ond , is we invest in technology and better ways of working so that our ...
Other editions - View all
Common terms and phrases
10S+ BCBS Standard 11 BLUE CROSS 1R ALLIANCE HEALTH 31H GEHA BENEFIT 31S GEHA BENEFIT 32 NALC HEALTH 36S POSTMASTERS BENEFIT 38 NATIONAL RURAL 44 SAMBA HEALTH 45H MAIL HANDLERS AETNA US HEALTHCARE ALLIANCE HEALTH BENEFIT AMERICAN FOREIGN SERVICE AMERICAN POSTAL WORKERS April 11 ASSOCIATION BENEFIT PLAN BLUE SHIELD SERVICE CODE YQ/YK/YA competitive costs CROSS AND BLUE Family Self Family Family Total fee-for-service fee-for-service plans FEHBP FOREIGN SERVICE PROTECTIVE GEHA BENEFIT PLAN GROUP HEALTH COOPERATIVE HANDLERS BENEFIT PLAN HBDF PLAN TOTALS HEALTH BENEFIT PLAN KAISER FOUNDATION HP LETTER CARRIERS ASSOCIATION MAIL HANDLERS BENEFIT Medicare beneficiaries NALC HEALTH BENEFIT NATIONAL RURAL LETTER percent Plan Total Contracts PLAN TOTALS 2002 PLAN WAS CODE POSTAL WORKERS UNION POSTMASTERS BENEFIT PLAN QUAM RURAL LETTER CARRIERS SAMBA HEALTH BENEFIT Senator BAUCUS Senator BREAUX SERVICE PROTECTIVE ASSOCIATION SHIELD SERVICE BASIC Standard plus plans Total Self Family TRICARE UNION HEALTH PLAN WORKERS UNION HEALTH
Popular passages
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...