Medicare Contracting Risk/Medicare Risk Contracting: A Life-Cycle View from Twelve Markets

Medicare contracting risk/Medicare risk contracting: a life-cycle view from twelve markets.

OBJECTIVE To examine the evolution of the Medicare HMO program from 1996 to 2001 in 12 nationally representative urban markets by exploring how the separate and confluent influences of government policy initiatives and health plans' strategic aims and operational experience affected the availability of HMOs to Medicare beneficiaries. DATA SOURCE Qualitative data gathered from 12 nationally re...

Medicare risk contracting: Determinants of market entry

The Tax Equity and Fiscal Responsibility Act (TEFRA) of 1982 made it more attractive for health maintenance organizations (HMOs) and other competitive medical plans to enter into risk contracts with Medicare. Since the start of the TEFRA program in April 1985, more than 160 HMOs have had risk contracts with Medicare under the program. An investigation of factors associated with TEFRA risk-marke...

Provider Opt-Out Under Medicare Private Contracting

The 1997 Balanced Budget Act (BBA) permits private contracting for care between Medicare beneficiaries and providers who have opted out of Medicare. This article examines the number and characteristics of providers who have opted-out, their role in the provision of Part B services, and their impact on beneficiary access from 1998 to 2002. Opt-out providers differ from providers remaining in Med...

Ready for risk contracting?

Before taking on value-based care, hospitals must assess risk capacity.

Markets and Contracting in Health Care