Medicare's POS option

Article Abstract:

Many health maintenance organizations (HMOs) are offering a point-of-service (POS) benefit to their members on Medicare. POS benefits allow patients to choose their own health care providers at an additional cost for each out-of-network service. This benefit package can be structured in one of four ways. Research shows that only 6% of qualified HMO members have bought the POS benefit and only 16% used this benefit in 1993.

Services, Marketing, Health insurance, Health maintenance organizations

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Do risk contracts save Medicare money?

Article Abstract:

The risk adjustments used to determine capitation rates paid to risk health maintenance organizations (HMOs) for Medicare members need to be improved. Risk adjustments include the beneficiary's age, gender, institutional status and employer-based health plan coverage. More accurate adjustments would be based on identifying high-cost medical conditions and by paying HMOs partly on a fee-for-service basis.

Standards, Risk assessment, Evaluation, Economic aspects, Managed care plans (Medical care), Capitated payment systems (Medical care)

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