The National Academies Press

Currently Skimming:

Index
Pages 353-368

The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.

From page 353... ... , 14-15, 16, 77, 84, 152, 170, 227 Advocacy/advocates, 42-43, 61, 154, 207, B 315-316 Aetna, 176 Baby boom generation, 1 Agency for Health Care Policy and Balanced Budget Act of 1995, 5, 33. See Research, 5, 34, 67, 156, 245, 275- also Omnibus Budget 276, 285, 320 Reconciliation Act of 1995 Alabama, 261 Beneficiaries, Medicare. Read the entire page →
From page 354... ... See also individual case Centers for Disease Control and studies Prevention, 259 benchmarks, 143, 151, 156-157 Centers of excellence, 156-157 concept, 34 Choice of health plan options. See also HMO, 320-321 Informed purchasing in purchasing plans, 151-152 benefit plan designs and, 192 Read the entire page →
From page 355... ... See also case studies, 35-36 Enrollment commissioned papers, 34-35 employer health plans, 175 composition, 8, 38 Medicare managed care providers, focus, 6-8, 33-34, 36-38 76-77 study approach, 33-38 recommendations, 81-82, 101, 102 tasks, 4-5, 28-29 103, 104 Commonwealth Fund, 25 Connecticut Business and Industry Commonwealth Program for Patient- Association Centered Care, 271, 275-276, 283 assessment of program, 178-179 Communication with beneficiaries. See benefits structure, 176-177, 192 also Consumer education; enrollee information, 177-178, 189 Read the entire page →
From page 356... ... See also Consumer protection. See also Communication with beneficiaries Standards and standards setting and accountability, 153-155 accountability distinguished from, 30 and disenrollment, 54-55 counseling and advocacy services, by employers, 95, 169-170, 173-174, 315-316 249-250, 256 government role, 312-313 funding for, 64, 65, 71, 95, 96-97, information safeguards, 68-69 184-185 policy issues, 312-319 by health plans, 78, 79, 153-154, 167- standards, 316-317, 322 168, 250-251, 253, 254, 255, 261 Consumer Reports, 245 by insurance counseling programs, Consumers 64-65, 254 definition of high-quality care, 271 in libraries, 244, 248, 257 274 literacy considerations, 67 patients as, 44 marketing conflicts of interest, 64, public accountability role, 42-43 70, 95 Cooperative for Health Insurance by nonprofit organizations, 65, 177- Purchasing (Colorado) Read the entire page →
From page 357... ... See beneficiaries; Consumer Service delivery education; Consumer information Demographics Downs, Hugh, 255-256 Medicare managed care enrollees, 16-21 Medicare market, 23-25 E Dental care, 19 Ear examinations, 16, 20 Department of Veterans Affairs, 274 Elder Service Plan, 220-221 Diabetes, 331-332 Elderly people Directories of physicians and benefit ability to make informed choices, 7, options, 49, 189 24-25, 27, 28, 32-33, 37, 44 Disabled people/disability attitudes about managed care, 276 age, 200 communication preferences and capabilities for informed approaches, 237-241, 263-264 decisionmaking, 44 concerns of, 6, 7, 27, 36, 50 costs of care, 203 enrolled in Medicare, 11 evaluation of impairment, 202-203 expenditures for, 26, 199-200 Medicare enrollees, 196 health literacy, 4, 25, 27-28 problems of, 202-203 income, 24, 25 satisfaction with care, 66, 295, 300 market segments, 240-241 types of impairments, 202-203 oldest old, 23, 197 Discrimination against high-risk own physician vs. HMO, 20-21, 27, patients, 26. Read the entire page →
From page 358... ... 358 INDEX lock-in provisions, 85, 86, 89, 297- Focus group studies 298, 332 communication with older adults, Medicare managed care, 14, 22, 27, 243-245 78, 330 consumer education, 60, 63, 335 minimums for participation, 151 satisfaction with care, 66-67, 272, open, 169, 173, 177, 192-193, 330 273, 274, 284, 295-296 period, 192-193 Foot care, 20, 60 recommendations, 84, 86 Foundation for Accountability, 5, 34, 73, reenrollment, 14, 178, 192-193 103, 144, 156 strategies/processes, 14, 22, 27, 78, Frederick/Schneiders, Inc., 276 169, 173, 177, 178, 192-193, 330 Frontier Community Health Plans, 180 statistics, 18-19 traditional Medicare, 11-12, 18-19 Eye examinations, 16, 20 G Gag rules, 10, 62, 100 F Georgia, 259 Geriatricians and geriatric assessment, Fallon Healthcare System, 220-221 52, 217-218 Family HealthCare Services, 221 Golf Digest, 239 Federal Employees Health Benefits Grievances and complaints Plan, 41, 138, 146-148, 155, 157 communcation of information on, Federal Trade Commission, 254 225-226, 316 Fee-for-service plans HMOs, 302-303 and accountability, 142-143 Medicare-covered services, 301-302 grievances and appeal procedures, 72 Medicare HMOs, 303-304 home health care in, 211-212 monitoring and tracking, 49, 292 information needs, 57, 277 processes, 71-72, 84, 302-303 Medicare, 39, 82-83 recommendations, 84, 87 premiums, 166-167 reporting of, 154 private, 40, 78 review and resolution process, 87, quality of care, 210 303-304 satisfaction with, 290, 293-295 satisfaction with responses to, 61 self-insured, 164 Group Health Association of America and utilization, 26 (GHAA) , 186, 243, 256 viability of, 82-83 Group Health Cooperative of Puget FHP, Inc., 164, 180 Sound, 53, 154, 219 Financial Accounting Standards Board, 156 Firman, James, 155 H Florida Hawaii, 262 HMO enrollees, 16, 18, 152, 196 Health Care Financing Administration plan marketing requirements, 307 beneficiary/customer plan purchasing strategies, 149, 152 communications, 35, 333-335 quality of care, 69 educational materials, 56, 245-247, risk-based HMOs, 52 253 satisfaction with care, 147 educational role, 5, 72-74 Florida Community Health Purchasing financial review, 331 Alliances, 149 Read the entire page →
From page 359... ... See also Choice of health Demonstrations, 255, 335-336 plan options ONLINE computer service, 336 consumer education by, 78, 79, 167 oversight of managed care, 73, 305, 168, 250-251, 253, 254, 255, 261 327, 328-333 high deductible, 40 patient satisfaction surveys, 320 number and type offered, 80-82, 148, quality assurance role, 73, 292, 310- 172-173, 175, 191 311 portability, 60, 61, 85 recommended role, 83-84, 107-110 Health Professional Shortage Areas, Small Business Innovation Research, 105 262 Health status Health care market, structural change, and disenrollment, 214-215 39-40 of Medicare HMO enrollees, 201 Health care professionals. See also retiree concerns, 50 Physicians and risk selection, 25-27 public accountability role, 43, 155- and satisfaction with care, 66, 291 157 self-assessed, 200-201 Health care resources, geographic of vulnerable populations, 200-201 distribution, 44 n.4 HealthChoice, Inc. Read the entire page →
From page 360... ... See illness-episode approach, 283 also Communication with literature on, 34, 279-280 beneficiaries; Consumer market competition and, 32 education; Consumer information policy issues, 193-194 appeal and grievance options, 72 responsibility for, 32-33 benefit packages, 58, 59, 284-285 and satisfaction with care, 85 comparability of plans, 57-58, 73, 78, selection approach, 160-161 89, 97-99, 161, 188, 224 Institute for Health Policy Solutions, coverage limits, 61, 79, 153 149 credentialing standards, 106 Insurance counseling groups, 61, 315 disenrollment rates, 51 316, 334-335 financial, 61, 79, 96 Integrated provider networks, 308-309 focus group research, 243-245, 276- Internet, 73, 90, 256, 257 279 Interplan reciprocity, 86 interviews with decision makers, 280-282 managed care system, 56 J marketing-related, 88-89 Joint Commission on the Accreditation Medicare program, 56 of Healthcare Organizations performance, 61-62 (JCAHO) , 90, 103, 156 physician incentives and restrictions, Joint pain, 53 61, 62, 153, 154, 228 provider lists, 62 quality of care, 59-62, 103, 105, 224, K 274-275, 283, 285 recommendations, 89-91, 92-93, 282- Kaiser Family Foundation, 25-26, 63-64, 286 243 research on, 315 Kaiser Foundation Health Plan of specific plans, 58-59 Colorado, 219-220 structural, 59, 61 Kaiser Permanente, 164, 168, 176, 180, terminology considerations, 99, 189 189, 216 topology of, 284-285 Kendall, David, 75-76, 154-155 Informed Choice Fund, 87, 95, 96-97 Kentucky, 149 Informed purchasing. Read the entire page →
From page 361... ... INDEX 361 Lewin-VHI, 149-150 rules of conduct, 88, 99, 330-331, 349 LIA Health Alliance, 149 social marketing, 265 Libraries, information distribution state oversight of, 307 through, 248, 257 telephone, 88, 254 Licensure, 69, 307, 311 Massachusetts, 262 Life expectancy, 199, 200 Mathematica Policy Research, Inc., 67, Long, Steve, 148 208, 298 n.3 Long-term care, 52, 60, 220-221 McCarran-Ferguson Act, 317 LTV, 250 Media, focus on discord and contention, 36 Medicaid, 13, 205, 309-311 M Medical necessity, 101 Medical Savings Accounts, 21, 40, 77-78 Managed care organizations. See also Medicare Advocacy Project, 296 Medicare managed care Medicare Beneficiaries Defense Fund, accountability for, 31 249 defined, 30 Medicare choices enrollment, 2 administration of, 107-110, 141-142 experience with vulnerable context for government involvement, populations, 206-207, 227 139-141 financial information, 61, 78 demonstration project, 15-16, 22, marketing costs, 55 335-336 state regulation, 305-311 "Medicare choices," use of term by IOM target membership, 50 committee defined, 9 n.3, 29-30; types of providers, 2-3 See also Choice of health plan types regulated, 313 options; Informed purchasing; Managed Risk Medical Insurance Marketing of Medicare choices Board, 171, 172, 173 Medicare Competitions Demonstrations, Marketing of Medicare choices 208, 214-215 abuses, 70, 87-88, 95, 145, 296-297, Medicare Current Beneficiary Survey, 314-315, 318, 349 25, 67, 200 administration, 10 Medicare Customer Service and blending market segments, 181-182 Enrollment Center, 91, 94-95, 96, for comparability, 10, 97-98, 182 97, 99, 105, 109 commissions/compensation Medicare Handbook, 56, 73, 246, 247, arrangements, 88, 174, 178-179, 334 180 Medicare managed care defined, 238 appeals procedures, 62, 71-72, 86, distinguished from education, 64, 70, 225-226 95 benefits, 21 door-to-door, 70, 88, 318 comparability charts, 334 information materials, 88, 179, 182, conditions of participation, 76-77, 81 250-251, 299 82 policy issues, 194 cost sharing, 22 prohibited practices, 330 delivery of services, 215-223, 329-330 public oversight, 264-265, 330 disenrollment, 54, 78, 214-215 by purchasing cooperatives, 71 enrollees, 2, 18-19, 54, 327-328 recommendations, 10, 84, 87-89, 97 enrollment process, 14, 22, 27, 78, 98, 99 330 Read the entire page →
From page 362... ... , see Balanced overview of requirements, 13-16, Budget Act of 1995 326-336 Medicare SELECT, 15 patient satisfaction, 213-214 Medigap insurance, 9, 13, 14, 69, 70, 84, payments to plans, 14-15, 21, 77 87-89, 97, 98, 100 population characteristics, 16-21 Mental health treatment, 165, 171 profit potentials, 146 Mental illness, 212 purchasing style, 77 Minnesota quality assurance, 331-332 community integrated service research and demonstrations, 335- networks, 309 336 HMO oversight, 154, 307, 308, 309 rights of beneficiaries, 332 outcomes research, 311 savings, 195 n.1 Minnesota Employees Insurance standards for providers, 21, 150-151 Program, 49-50, 149; see also statutory basis, 327 Southern California Edison Medicare Managed Risk Program, 208, health program 221 Minnesota Health Data Institute, 251Medicare market. See also Marketing of 252, 260, 293-294 Medicare choices Model HMO Act of the National demographics, 23-25 Association of Insurance federal role in, 312-313 Commissioners, 306, 317 health status, 25-27 Model programs. Read the entire page →
From page 363... ... See Satisfaction Ohio, 311 with managed care Ombudspersons, 42-43, 94, 154, 316, 350 Peer review organizations, 292, 304, Omnibus Budget Reconciliation Act of 305, 316, 331-332 1985, 326 Pennsylvania, 307 Omnibus Budget Reconciliation Act of Perfect competition theory, 140 1987, 326 Performance Omnibus Budget Reconciliation Act of assessment measures, 144, 182, 224 1990, 315, 326, 335 225 Omnibus Budget Reconciliation Act of complaint rates, 154 1995 data, 74, 346-347 accreditation requirements, 156 enforcement measures, 154, 224 advantages and disadvantages, 146- incentives, 182 147 policy issues, 193-194 contracting standards, 305 professionalism and, 10, 44-45, 58, DHHS responsibilities under, 145 61, 84, 100, 101, 140-141, 144-145 enrollment requirements, 151 report cards, 49, 144, 145, 151, 167 as a framework for reform, 5, 33 168 goals for Medicare, 137-138 standards, 169, 187 improvements needed in, 78-79 Physical adaptation of homes, 52 Read the entire page →
From page 364... ... See directories/lists, 49, 62, 298, 314-315 Health care professionals education of, 171 Program of All-Inclusive Care for the importance of communication to, 271 Elderly/On Lok projects, 220 out-of-plan, 302 Progressive Policy Institute, 154-155 payment incentives, 10, 58, 61, 84, Prospective Payment Assessment 100, 101, 228, 321 Commission (ProPAC) , 83, 320 professional judgments on care, 44-45 Provider lists, 49, 62, 189, 298, 314-315 recommendations for, 10, 100-101 Provider service networks, 21 risk selection by, 46 Provider-sponsored organizations, 305, sources of patient dissatisfaction, 308-309 300, 302-303 Prudential HealthCare System, 164 Physicians Health Service, 176 Public accountability Picker Institute for Patient-Centered committee focus, 6-7, 8, 36-37 Care, 66, 271, 272-274, 275-276, conceptual framework, 34-35 283, 284 consumer role, 40, 42-43, 153-155 PlanSource (Kentucky) Read the entire page →
From page 365... ... See also Satisfaction 84 with managed care standardization of benefit plans, 98 consumer definitions of, 271-274 100 data collection on, 74, 347-348 Reconciliation bill. See Omnibus Budget defined, 3 n.2, 52, 273-274 Reconciliation Act of 1995 external review, 224-225 Referrals to specialists, 53, 61, 65, 66, indicators, 73 101, 209, 298, 300, 307, 314-315 information wanted by consumers, Regulation of managed care 58-62, 274-275 organizations. Read the entire page →
From page 366... ... See Private rating system, 66-67 health care sector research recommendations, 319-320 Risk selection sources of dissatisfaction, 65, 291-300 AAPCC methodology and, 227-228 standardization of data, 224 adverse, 26-27, 45-46, 78, 146, 162, survey results, 65-66, 67, 213-214 176 Read the entire page →
From page 367... ... Foundation, 244, 258, 259 service delivery arrangements, 308Sierra Health Services, 221 309 Skilled nursing services, 12 Stocker, Michael, 153 Social HMOs, 15, 220-221 Strategic Directions, 241 Social Security Act, 327 Substance abuse treatment, 165 Social Security Administration, 244, Support programs, 52 246, 248, 256, 258-259, 261, 302, Surveys. See also individual surveys 332 communications preferences of Social Security income, 205 beneficiaries, 239-240 South Carolina, 262 exit, 349 South Dakota, 307 health status, 200-201 Southern California Edison health HMO enrollees, 292-293 program Medicare HMO enrollees, 293-295 beneficiaries, 168 quality of care, 347-348, 349 educating employees on, 169-170, satisfaction with care, 65-66, 67, 189, 188, 189, 190, 191, 194 213-214, 319-320 enrollment, 169 standardization, 91 improvements anticipated, 170-171 Symposium performance standards, 169 organization, 36 process for choosing plans, 168-169 participants, 34 types of plans, 168 Southern Living, 239 Standardization T of benefit plans, 47, 49, 69-70, 73, 98, Tax Equity and Financial Responsibility 99, 161, 184, 186, 192, 344-345 Act, 13, 326 consumer satisfaction data, 224 Telemarketing Act of 1994, 254 of surveys, 91 Read the entire page →
From page 368... ... , 248 UltraLink, 164, 250 Wisconsin Employee Trust Fund Union Carbide, 250 benefit plan standardization, 184, United Seniors Health Cooperative, 61, 192 65, 262 consumer education, 184-185 University of Minnesota, 222 information dissemination, 185-186 U.S. Department of Defense, 73, 150 price negotiation, 183-184 U.S. Read the entire page →

From page 353...

... , 14-15, 16, 77, 84, 152, 170, 227 Advocacy/advocates, 42-43, 61, 154, 207, B 315-316 Aetna, 176 Baby boom generation, 1 Agency for Health Care Policy and Balanced Budget Act of 1995, 5, 33. See Research, 5, 34, 67, 156, 245, 275- also Omnibus Budget 276, 285, 320 Reconciliation Act of 1995 Alabama, 261 Beneficiaries, Medicare.

Index Pages 353-368

Index
Pages 353-368