How ready are health plans for Medicare?
BACKGROUND
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.


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


METHODS
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.
Gaumer
G
G
Health Care Associates Plus, Cambridge, MA, USA.
Moore
T
T
Friedman
M
M
Bix
B
B
D000368:Aged; D002204:Capitation Fee; D019090:Case Management; D002908:Chronic Disease / Q000191:economics; D003625:Data Collection; D004502:Education, Medical, Continuing; D016330:Frail Elderly; D005853:Geriatrics / Q000191:economics; D006279:Health Maintenance Organizations / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D016345:Medicare Part B / Q000458:organization & administration*; D017063:Outcome Assessment, Health Care; D012307:Risk Factors; D020414:Risk Sharing, Financial; D012648:Self Care; D014481:United States; D014600:Utilization Review