Evaluation of the ESRD managed care demonstration operations.
Individuals with end stage renal disease (ESRD), most of whom are insured by Medicare, are generally prohibited from enrolling in Medicare managed care plans (MCPs). CMS offered ESRD patients the opportunity to participate in an ESRD managed care demonstration mandated by Congress. The demonstration tested whether managed care systems would be of interest to ESRD patients and whether these approaches would be operationally feasible and efficient for treating ESRD patients. This article examines the structure, implementation, and operational outcomes of the three demonstration sites, focusing on: the structure of these managed care programs for ESRD patients, requirements needed to attract and enroll patients, and the challenges of introducing managed care programs in the ESRD arena.
Oppenheimer
Caitlin Carroll
CC
National Opinion Research Center, Washington, DC 20036, USA. oppenheimer-caitlin@norcmail.uchicago.edu
Shapiro
Jennifer R
JR
Beronja
Nancy
N
Dykstra
Dawn M
DM
Gaylin
Daniel S
DS
Held
Philip J
PJ
Rubin
Robert J
RJ
D002140:California; D014487:Centers for Medicare and Medicaid Services, U.S.; D017281:Cost of Illness; D005260:Female; D005431:Florida; D017048:Health Care Costs; D006279:Health Maintenance Organizations / Q000191:economics* / Q000592:standards; D006801:Humans; D019458:Insurance Coverage; D007676:Kidney Failure, Chronic / Q000191:economics* / Q000628:therapy*; D008297:Male; D006278:Medicare / Q000331:legislation & jurisprudence*; D008875:Middle Aged; D010865:Pilot Projects; D011787:Quality of Health Care; D006435:Renal Dialysis / Q000191:economics* / Q000592:standards; D013714:Tennessee; D014481:United States