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 sector--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 care--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.
Stanley B. Jones and Marion Ein Lewin, Editors; Committee on Choice and Managed Care: Assuring Public Accountability and Information for Informed Purchasing by and on Behalf of Medicare Beneficiaries, Institute of Medicine
1 Front Matter; 2 Executive Summary; 3 1 Overview; 4 2 Symposium Summary; 5 3 Findings and Reccomendations; 6 References; 7 References Consulted; 8 A Additional Commentary Regarding Choice Facilitating Organizations; 9 B Invitational Symposium Agenda; 10 C Symposium Participants; 11 D Commissioned Papers; 12 E The Structure and Accountability for Medicare Health Plans: Government, the Market, and Professionalism; 13 F Best Practices for Structuring and Facilitating Consumer Choice of Health Plans; 14 G Medicare Managed Care: Issues for Vulnerable Populations; 15 H Reaching and Educating Medicare Benificiaries About Choice; 16 I What Information Do Consumers Want and Need: What Do We Know About How They Judge Quality and Accountability?; 17 J Medicare Managed Care: Protecting Consumers and Enhancing Satisfaction; 18 K Medicare Managed Care: Current Requirements and Practices to Ensure Accountability; 19 L What Should Be the Basic Ground Rules for Plans Being Able to Participate in the Medicare Managed Care Market? Case Study: The California Public Employees' Retirement System; 20 Index