Adjusted community rate reforms to promote HMO participation in Medicare+Choice.
The authors review the financial regulations imposed on health maintenance organizations (HMOs) that participate in the Medicare+Choice program and identify elements of the regulations that may discourage HMO participation in the program. Modifications of the regulations are proposed that could encourage the participation of HMOs without affording them excessive profit. The modifications include smoothing and bounding profit estimates and authorizing and encouraging expanded use of benefit stabilization funds.
Encinosa
W E
WE
University of Florida, USA.
Sappington
D E
DE
D000368:Aged; D003284:Contract Services / Q000191:economics; D006279:Health Maintenance Organizations / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007182:Income; D020398:Medicare Part C / Q000458:organization & administration / Q000706:statistics & numerical data*; D020406:Medicare Payment Advisory Commission; D017059:Models, Econometric; D009936:Organizational Innovation; D011907:Rate Setting and Review / Q000706:statistics & numerical data*; D020379:Risk Adjustment; D020414:Risk Sharing, Financial; D014481:United States