Monitoring and evaluating the delivery of services under managed care.

This overview discusses the importance of monitoring and evaluating the delivery of services under managed care, particularly with respect to assessing access and quality in managed care. It also lists recent Health Care Financing Administration (HCFA) initiatives in this area, and presents an introduction to the articles published in this issue of the Review. The topics addressed by these articles range from assessing and monitoring access and quality provided by traditional types of managed care organizations (MCOs) serving Medicare and Medicaid beneficiaries to issues that must be considered in developing and monitoring new delivery system models.

Medicaid and state health care reform: process, programs, and policy options.

Health care reform is a continuously evolving process. The States and the Federal Government have struggled with policy issues to combat escalating Medicaid expenditures while ensuring access and quality of care to an ever-expanding population. In the absence of national health care reform, States are increasingly relying on Federal waivers to develop innovative approaches to address a myriad of issues associated with the present health care delivery system. This article provides a summary of State health care reform efforts that have been initiated under Federal waiver authority.

Managed care in the United States: promises, evidence to date and future directions.

In the United States, health maintenance organizations (HMOs) and preferred provider organizations (PPOs) have proliferated during the past decade. To a great extent, their growth has been based on the perceived promise of these organizations to reduce health care costs without compromising quality of care and introduce a level of competition into the health care market that would result in a more efficient and effective health care system. This paper examines the promise of managed care as delivered through HMOs and PPOs, the evidence to date on the extent to which their promise has been met, and recent developments in the organization of managed care systems.

Evaluation of the Medicare competition demonstrations.

A summary of findings from the Evaluation of the Medicare Competition Demonstrations is presented in this article. The purpose of this evaluation was to examine the implementation and operational experiences of the 26 health maintenance organizations that operated as demonstrations from 1983 to 1985, their experiences in marketing their plans, the factors that affected beneficiaries' decisions to join or not join a plan, the extent to which beneficiaries were satisfied with their choice of plans, the quality of care provided by the plans, and the impact of the demonstrations on Medicare beneficiaries' use and cost of services.

HMOs in the Medicare market. Part 1.

Final governmental regulations permitting all qualified health maintenance organizations and competitive medical plans to enter the Medicare market were published early last year. This action has created a significant need for information on marketing strategies and operational issues pertaining to this new area. Mathematica Policy Research was awarded a grant by HCFA to evaluate the Medicare Competition Demonstration program undertaken by 26 HMOs and CMPs between August 1982 and December 1984, with a focus on the marketing strategies and operational decisions and changes during the initial period of entering the Medicare market. In this first part of a two-part report, information is provided on the marketing approaches developed by the demonstration HMOs as they dealt with, in most cases, a large influx of elderly enrollees.

Capitation and the Medicare program: history, issues, and evidence.

This article reviews the history of capitation in the Medicare program and examines issues and research findings related to Medicare capitation. Specific capitation issues and related research findings reviewed include: the feasibility and extent of health maintenance organization participation in Medicare; plan marketing; beneficiary choice behavior; quality of care; and the use and cost of services. In addition, areas requiring further study are noted, and the potential for extensions of capitation under Medicare are explored.