Medicaid managed care shapes rural health in Oregon

Article Abstract:

The Oregon Health Plan has extended its mandatory managed care plan for Medicaid services to rural parts of the state since 1994. Enrollment in the plan increased from 90,000 to 300,000, as eligibility was increased to persons at 100% of the poverty level. More than 90% of physicians joined the plan, as reimbursement rose to 70 cents on the dollar. Most of the rural doctors' difficulties with measures of quality and utilization standards have been resolved. The state must now cut the program to avoid a shortfall.

Health Maintenance Organizations, HMO Medical Centers, Health Programs-State, Health policy, Oregon, Rural health services

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Managed care making sure physicians stay within specialties

Article Abstract:

Large health insurance companies, such as Aetna Insurance Co and CIGNA Corp, are scrutinizing the specialty board qualifications of physicians before approving claims. Company staff will question physicians who specify Current Procedural Technology codes for which they do not qualify, and payment may be denied. Managed care firms are checking with the American Board of Medical Specialties to verify physicians' claims of certification. The existence of other standards boards confuses the task.

Offices & clinics of medical doctors, Accident and health insurance, Medicine, Insurance industry, Medical specialties

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Maryland to test new Medicaid managed care pay formula

Article Abstract:

Maryland will be the first state to test a new capitation formula under a new statewide Medicaid managed care program to begin in Mar 1997. The program will replace a voluntary program for 330,000 Medicaid recipients in the state. The new pay formula, called ambulatory care groups, will increase reimbursements for sicker patients.

Health Care, Health Care and Social Assistance, Medicaid, Usage, Health care industry, Medical care, Maryland, Capitated payment systems (Medical care)

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