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Medicare Provider Service Networks
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Author :United States. Congress. House. Committee on Commerce. Subcommittee on Health and the Environment Publisher : ISBN 13 : Total Pages :120 pages Book Rating :4.F/5 ( download)
Book Synopsis Medicare Provider Service Networks by : United States. Congress. House. Committee on Commerce. Subcommittee on Health and the Environment
Download or read book Medicare Provider Service Networks written by United States. Congress. House. Committee on Commerce. Subcommittee on Health and the Environment and published by . This book was released on 1997 with total page 120 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Medicare Provider Service Networks by : Michael Bilirakis
Download or read book Medicare Provider Service Networks written by Michael Bilirakis and published by DIANE Publishing. This book was released on 1999-12 with total page 115 pages. Available in PDF, EPUB and Kindle. Book excerpt: A hearing on the important issue of establishing provider-sponsored networks, called PSNs, in the Medicare program. Although all sides agree that PSNs should be able to participate as Medicare risk contractors, there is a fundamental disagreement on how they should be regulated, particularly in regard to solvency standards. Testimony from the following organizations: Amer. Acad. of Actuaries; Amer. Medical Assoc.; Health Insur. Assoc. of Amer.; Blue Cross & Blue Shield; Amer. Medical Group Assoc.; Amer. Hospital Assoc.; various insurers; Amer. Assoc. of Health Plans; & the Premier Inst.
Author :United States. Congress. House. Committee on Commerce. Subcommittee on Health and the Environment Publisher : ISBN 13 : Total Pages :120 pages Book Rating :4.0/5 ( download)
Book Synopsis Medicare Provider Service Networks by : United States. Congress. House. Committee on Commerce. Subcommittee on Health and the Environment
Download or read book Medicare Provider Service Networks written by United States. Congress. House. Committee on Commerce. Subcommittee on Health and the Environment and published by . This book was released on 1997 with total page 120 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Medicare Advantage by : James Cosgrove
Download or read book Medicare Advantage written by James Cosgrove and published by . This book was released on 2015-11-23 with total page 50 pages. Available in PDF, EPUB and Kindle. Book excerpt: Medicare Advantage Organizations (MAOs) contract with a network of providers to manage health care delivery to their enrollees. MAOs can initiate or terminate contracts with providers at any time for any reason. Recently, some MAOs have been narrowing their provider networks, prompting concerns about ensuring enrollee access to care and CMS's oversight of MAO compliance with network adequacy criteria. This report examines (1) how the Centers for Medicare & Medicaid Services (CMS) defines network adequacy and how its criteria compares with other programs; (2) how and when CMS applies its criteria; and (3) the extent to which CMS conducts ongoing monitoring of MAO networks; and (4) how CMS ensures that MAOs inform beneficiaries about terminations. Tables. This is a print on demand report.
Download or read book The Medicare Handbook written by and published by . This book was released on 1992 with total page 12 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Measuring Restrictiveness of Medicare Advantage Networks by : Yevgeniy Feyman
Download or read book Measuring Restrictiveness of Medicare Advantage Networks written by Yevgeniy Feyman and published by . This book was released on 2023 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: As is common in the private insurance market, insurers offering Medicare Advantage (MA) plans typically restrict the network of providers from which patients can seek care. Existing work evaluating the breadth of these provider networks relies on provider directories and typically measures breadth as the fraction of providers in-network within some geography. However, well-documented errors prevalent in provider directories and data identifying provider locations can lead to errors with this approach. We use Medicare prescription drug event data from 2011 to 2017 to identify interactions between MA beneficiaries and providers, creating a predictive model that estimates counterfactual utilization to measure the degree to which networks restrict the number of providers seen by patients. We detail the construction, tuning, and estimation of this model for one high-prescribing specialty (primary care). A random forest model outperformed other choices. Our estimates indicate that, as theory predicts, preferred provider organizations (PPOs) are less restrictive than health maintenance organizations (HMOs), that issuers with higher market share impose more restrictive networks, and that increased provider supply is associated with less restrictive networks. These results help validate our methodological approach, providing justification for application more generally.We also provide guidance on how our approach can be replicated for other markets and/or specialties.
Book Synopsis The Role of Managed Care Organizations within the Healthcare Industry by : Patrick Kimuyu
Download or read book The Role of Managed Care Organizations within the Healthcare Industry written by Patrick Kimuyu and published by GRIN Verlag. This book was released on 2018-02-01 with total page 19 pages. Available in PDF, EPUB and Kindle. Book excerpt: Seminar paper from the year 2018 in the subject Medicine - Medical Frontiers and Special Areas, grade: 1, Egerton University, language: English, abstract: This paper will provide a comprehensive overview of managed care, primarily on the advantages and disadvantages of managed care organizations. Over the decades, the United States’ healthcare system has been experiencing challenges. In general, the cost and quality of care has always been considered as the most critical factors that influence healthcare sustainability in the United States and the world, as a whole. As a result, a series of value-based payment reforms have been introduced. For instance, the Affordable Care Act (ACA) of 2010 introduced payment and delivery system reforms. From a critical perspective, the reforms introduced by the ACA have addressed the long-standing problems which have been posing enormous hindrances to the development of the U.S. healthcare system. Above all, it has enhanced managed care through consolidating care, as well as, addressing the problem of unsustainable costs and uneven quality of care. However, managed care seems to exhibit some drawbacks too.
Book Synopsis Medicare Provider Service Networks... Hearing... Committee On Commerce... House Of Representatives... 105th Congress, 1st Session, March 19, 1997 by : United States. Congress. House. Committee on Commerce
Download or read book Medicare Provider Service Networks... Hearing... Committee On Commerce... House Of Representatives... 105th Congress, 1st Session, March 19, 1997 written by United States. Congress. House. Committee on Commerce and published by . This book was released on 1998* with total page pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Health Insurance and Managed Care by : Peter Reid Kongstvedt
Download or read book Health Insurance and Managed Care written by Peter Reid Kongstvedt and published by Jones & Bartlett Publishers. This book was released on 2016 with total page 418 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Author :United States Government Accountability Office Publisher :Createspace Independent Publishing Platform ISBN 13 :9781977956422 Total Pages :50 pages Book Rating :4.9/5 (564 download)
Book Synopsis Medicare Advantage by : United States Government Accountability Office
Download or read book Medicare Advantage written by United States Government Accountability Office and published by Createspace Independent Publishing Platform. This book was released on 2017-10-05 with total page 50 pages. Available in PDF, EPUB and Kindle. Book excerpt: MAOs contract with a network of providers to manage health care delivery to their enrollees. MAOs can initiate or terminate contracts with providers at any time for any reason. Recently, some MAOs have been narrowing their provider networks, prompting concerns about ensuring enrollee access to care and CMS's oversight of MAO compliance with network adequacy criteria. GAO was asked to review how CMS ensures adequate access to care for MA enrollees. This report examines (1) how CMS defines network adequacy and how its criteria compares with other programs, (2) how and when CMS applies its criteria, (3) the extent to which CMS conducts ongoing monitoring of MAO networks, and (4) how CMS ensures that MAOs inform beneficiaries about terminations. GAO reviewed CMS and other guidance on network adequacy, federal regulations, and standards for internal control. GAO also interviewed CMS officials and representatives of medical associations and beneficiary advocacy groups, and analyzed CMS data on oversight of MAO provider networks for contract years 2013 through 2015.
Book Synopsis America's Health Care Safety Net by : Institute of Medicine
Download or read book America's Health Care Safety Net written by Institute of Medicine and published by National Academies Press. This book was released on 2000-09-04 with total page 304 pages. Available in PDF, EPUB and Kindle. Book excerpt: America's Health Care Safety Net explains how competition and cost issues in today's health care marketplace are posing major challenges to continued access to care for America's poor and uninsured. At a time when policymakers and providers are urgently seeking guidance, the committee recommends concrete strategies for maintaining the viability of the safety netâ€"with innovative approaches to building public attention, developing better tools for tracking the problem, and designing effective interventions. This book examines the health care safety net from the perspectives of key providers and the populations they serve, including: Components of the safety netâ€"public hospitals, community clinics, local health departments, and federal and state programs. Mounting pressures on the systemâ€"rising numbers of uninsured patients, decline in Medicaid eligibility due to welfare reform, increasing health care access barriers for minority and immigrant populations, and more. Specific consequences for providers and their patients from the competitive, managed care environmentâ€"detailing the evolution and impact of Medicaid managed care. Key issues highlighted in four populationsâ€"children with special needs, people with serious mental illness, people with HIV/AIDS, and the homeless.
Book Synopsis The Role of Telehealth in an Evolving Health Care Environment by : Institute of Medicine
Download or read book The Role of Telehealth in an Evolving Health Care Environment written by Institute of Medicine and published by National Academies Press. This book was released on 2012-12-20 with total page 159 pages. Available in PDF, EPUB and Kindle. Book excerpt: In 1996, the Institute of Medicine (IOM) released its report Telemedicine: A Guide to Assessing Telecommunications for Health Care. In that report, the IOM Committee on Evaluating Clinical Applications of Telemedicine found telemedicine is similar in most respects to other technologies for which better evidence of effectiveness is also being demanded. Telemedicine, however, has some special characteristics-shared with information technologies generally-that warrant particular notice from evaluators and decision makers. Since that time, attention to telehealth has continued to grow in both the public and private sectors. Peer-reviewed journals and professional societies are devoted to telehealth, the federal government provides grant funding to promote the use of telehealth, and the private technology industry continues to develop new applications for telehealth. However, barriers remain to the use of telehealth modalities, including issues related to reimbursement, licensure, workforce, and costs. Also, some areas of telehealth have developed a stronger evidence base than others. The Health Resources and Service Administration (HRSA) sponsored the IOM in holding a workshop in Washington, DC, on August 8-9 2012, to examine how the use of telehealth technology can fit into the U.S. health care system. HRSA asked the IOM to focus on the potential for telehealth to serve geographically isolated individuals and extend the reach of scarce resources while also emphasizing the quality and value in the delivery of health care services. This workshop summary discusses the evolution of telehealth since 1996, including the increasing role of the private sector, policies that have promoted or delayed the use of telehealth, and consumer acceptance of telehealth. The Role of Telehealth in an Evolving Health Care Environment: Workshop Summary discusses the current evidence base for telehealth, including available data and gaps in data; discuss how technological developments, including mobile telehealth, electronic intensive care units, remote monitoring, social networking, and wearable devices, in conjunction with the push for electronic health records, is changing the delivery of health care in rural and urban environments. This report also summarizes actions that the U.S. Department of Health and Human Services (HHS) can undertake to further the use of telehealth to improve health care outcomes while controlling costs in the current health care environment.
Book Synopsis Accountable Care Organizations and the Medicare Shared Savings Program by : David Newman
Download or read book Accountable Care Organizations and the Medicare Shared Savings Program written by David Newman and published by DIANE Publishing. This book was released on 2010 with total page 23 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis 105-1 Hearing: Medicare Provider Service Networks, Serial No. 105-48, March 19, 1997 by : United States. Congress. House. Committee on Commerce
Download or read book 105-1 Hearing: Medicare Provider Service Networks, Serial No. 105-48, March 19, 1997 written by United States. Congress. House. Committee on Commerce and published by . This book was released on 1998* with total page pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Health Plans' Selection and Payment of Health Care Providers, 1999 by :
Download or read book Health Plans' Selection and Payment of Health Care Providers, 1999 written by and published by . This book was released on 2000 with total page 472 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Medicare written by Sarah F. Jaggar and published by . This book was released on 1995 with total page 22 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Improving the Medicare Market by : Institute of Medicine
Download or read book Improving the Medicare Market written by Institute of Medicine and published by National Academies Press. This book was released on 1996-11-01 with total page 384 pages. Available in PDF, EPUB and Kindle. Book excerpt: Medicare beneficiaries are rapidly moving into managed care, as attempts to restrain the growth of this costly entitlement program progress. However, advocates for patients question whether the necessary information and structures are in place to enable Medicare consumers to select wisely among private-sector managed care options. Improving the Medicare Market examines how to give Medicare beneficiaries the same choice of health plan options enjoyed in the private sectorâ€"yet protect them as consumers and patients. This book recommends approaches to ensuring accountability and informed purchasing for Medicare beneficiaries in an environment of broader choice and managed careâ€"how the government should evaluate and approve plans, what role the traditional Medicare program should play, how to help to elderly understand their options, and many other practical matters. The committee discusses the information requirements of Medicare beneficiaries and explores in detail how best to respond to their special needs. And it examines the procedures that should be developed to provide the necessary protections for the elderly in a managed care system.
