Geography and destiny: local-market perspectives on developing Medicare Advantage regional plans.
The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 established regional preferred provider organizations (PPOs) as a new private-plan option for beneficiaries in the Medicare Advantage (MA) program, starting in 2006. Developing network-based Medicare products uniformly priced across statewide or multistate regions presents unprecedented challenges and opportunities for health insurers. We held discussions with local health plan and hospital informants in six of the twelve Community Tracking Study (CTS) communities to obtain their perspectives on key considerations in evaluating whether they can and will offer regional PPO products under the MA program.
Hurley
Robert E
RE
Department of Health Administration, Virginia Commonwealth University, in Richmond, USA. rhurley@hsc.vcu.edu
Strunk
Bradley C
BC
Grossman
Joy M
JM
D000368:Aged; D004465:Economic Competition; D005843:Geography; D019981:Health Care Sector; D006279:Health Maintenance Organizations / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007356:Insurance, Pharmaceutical Services / Q000191:economics / Q000331:legislation & jurisprudence*; D008389:Marketing of Health Services; D006278:Medicare / Q000191:economics / Q000331:legislation & jurisprudence*; D011243:Preferred Provider Organizations / Q000191:economics* / Q000706:statistics & numerical data; D012040:Regional Health Planning; D014481:United States