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Developing an Information Infrastructure for the Medicare+Choice Program Summary of a Workshop (1999) / Chapter Skim
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3 HCFA as a Successful Consumer Service Agency
Pages 7-16

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From page 7...
... health plans, health care professionals, and other providers have a well-fimctioning market in which they can prosper by offering better quality, service, and efficiency. To set the stage for the March 1998 workshop and to help provide a framework for the meeting's presentations and discussion, the committee asked noted health care expert Lynn Etheredge to write a paper describing alternate roles that the Health Care Financing Administration could assume as it moves from its primarily payer role to its role as a consumer service agency.
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From page 8...
... HCFA has already done much preparatory work and is considering its future activities related to its new consumer service role. Some ideas and considerations that could enter into an overall HCFA management strategy for consumer service are discussed below.
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From page 9...
... Health plans, marketing experts, consumer advocacy agencies, health service researchers, health care professionals, accreditation agencies, data specialists, and state insurance departments all have gained useful insights. Large employers have led the way in moving more than 80 percent of their enrollees from traditional fee-for-service plans to managed care plans over the past decade and are also a valuable source of expertise.
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From page 10...
... ' They get really annoyed when ~ tell them they have to decide and ~ give them lots of tables." Market research that has been done for the Federal Employees Health Benefits Plan shows that individuals key their decisions to a small number of plan features; health plans use such information to design benefits packages and marketing strategies. HCFA can use understanding of consumer psychology, marketing strategies, and sales tactics to make sure that beneficiaries get their questions answered and to help them become better comparison shoppers.
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From page 11...
... A recent analysis of Medicare disenrolIment data by Families USA suggests that some geographic areas and health plans will have many problems (Families USA, 1997; Riley et al., 19971. In some states, the Medicare market seems to be working well: in Hawaii only 2.7 percent of Medicare HMO enrollees disenrolled in 1996, and in Minnesota only 4.2 percent disenrolled.
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From page 12...
... There is now enough of a history with Medicare HMOs to predict what major problems lie ahead, at least with certain health plans and in some parts of the country. HCFA staff need clear policy guidance about when and how to intervene with health plans and on the use of intermediate sanctions short of dismissal from the Medicare program.
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From page 13...
... Part of HCFA's strategy could be to coordinate with state insurance commissioners and the National Association of insurance Commissioners in identifying problem health plans, in providing individuals with assistance, and in using coordinated actions to bring health plans into compliance. in the past, managed care has seen fly-by-night operators and marketing firms moving from state to state as they stay "one step ahead of the sheriff." State health departments may also need to be involved with quality-of-care abuses.
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From page 14...
... , and HCFA-funded state health insurance consumer advisory programs. Although AARP has conflicting interests because of its business relationships with Medigap insurance and health plans, AARP chapters may be useful purveyors of information and advice.
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From page 15...
... IMPLEMENTATION HCFA faces a challenging new future as a consumer service agency. The major tasks at hand, if they are to be performed well, exceed its current capabilities.
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Key Terms

  • health plan
  • consumer service
  • medicare enrollees
  • medicare beneficiaries
  • care plans

  • service agency
  • hmo enrollees
  • medicare hmos
  • medicare hmo
  • medicaid program

  • hcfa staff
  • medicare population
  • care financing
  • individual assistance
  • million medicare

  • care plan
  • enrollees disenrolled
  • health insurance
  • insurance commissioners
  • medicare program

  • objective information
  • financing administration
  • employee benefits
  • care professionals
  • medicare health

  • program pays
  • accreditation agencies
  • families usa
  • consumer assessment
  • state insurance


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