managed care

A New Vision For Medicare: Breaking Down Barriers Between Medical Treatment And Personal Care

Since July 1 was the 50th anniversary of Medicare first enrolling (and paying benefits for) seniors, it’s a good time to think about modernizing the half-century old program. A couple of weeks ago I tried to make the case for why we should improve Medicare. Now, let’s think about how. Medicare needs to better serve a population of older adults [...]

By |2016-07-13T11:49:39-04:00July 13th, 2016|Medicare|1 Comment

What New Managed Care Regulations Will Mean For Frail Elders

Federal regulations are finally catching up with a decade of seismic change in the delivery of Medicaid services. More than 650 pages of proposed new rules are aimed at overseeing managed care, which has become the standard health care delivery system for low-income adults and children, and is now being expanded to include both medical care and long-term supports and [...]

By |2015-05-29T12:28:47-04:00May 29th, 2015|Care Coordination, Medicaid|0 Comments

Why are So Few Low-Income Seniors Enrolling in Managed Care Plans?

What if they gave a managed care plan and nobody came? That seems to be the problem with California’s ambitious effort to enroll more than 400,000 low-income seniors and younger people with disabilities into a fully-integrated care program that covers both medical treatment and long-term supports and services.  The idea has enormous promise, but relatively few Californians seem willing to [...]

By |2014-12-12T14:19:44-05:00December 12th, 2014|Care Coordination, Medicaid|2 Comments

The Real Value of ObamaCare Has Nothing to do with Enrollment

The loud debate over how many people have gotten health insurance under the Affordable Care Act misses the point. Yes, reducing the number of uninsured was one goal of the ACA. But only one. The law’s most enduring legacy will come from its historical—but largely unnoticed—changes in the way health care is delivered. Unlike the insurance expansion, which largely excludes Medicare, many [...]

The Boom in Medicare Managed Care

Despite the fears of consumer advocates and the predictions of many insurance companies, seniors are flocking to Medicare Advantage managed care plans. It shouldn’t be a surprise since premiums for these policies are a fraction of the cost of traditional fee-for-service Medicare. This shift may be one driver of the recent slowdown in the growth of health care costs and [...]

By |2013-11-27T20:12:30-05:00November 27th, 2013|Aging, Care Coordination, Medicare|1 Comment

The Promise and Risks of Medicare Managed Care

In 2012, about 13 million seniors participated in Medicare Advantage (MA) managed care plans—about 27 percent of the Medicare population and twice as many as were enrolled just seven years ago. This rapid shift to managed care by seniors may be just a first step towards a fundamental change in the way Medicare is delivered and financed. And it has the [...]

By |2012-12-26T16:36:45-05:00December 26th, 2012|Care Coordination, Health Care, Medicare|0 Comments

New Ways to Think About Long-Term Care Financing

In the past few months, important events and circumstances have highlighted the need for an effective, sustainable way to finance the often-astronomical costs of long-term care services and supports.  The growing political and financial pressures on Medicaid--the state/federal program that funds nearly half of all paid long-term care; the deepening problems in the private long-term care insurance market; and the demise of the CLASS Act--the failed attempt to [...]

Hill Panel Debates Managing Care for Dual Eligible Seniors

Everybody wants to do a better job coordinating care for the frail elderly and younger adults with disabilities who have extensive medical and personal care needs. But just how to do it is becoming increasingly controversial—especially on Capitol Hill. The current flashpoint is an aggressive new Obama Administration initiative aimed at improving care and cutting costs for those who are [...]

Private Insurers are Betting Big on Managed Care for “Dual Eligible” Seniors

Insurance giant Wellpoint is the latest carrier making a big bet on managing care for those seniors and adults with disabilities who are eligible for both Medicare and Medicaid.  About 9 million people, called “dual eligibles” receive benefits from both programs. They are both very poor and very sick and often have significant needs for personal assistance. Medicaid alone spends $145 [...]

A Hospital Stay—In Your Own Home

 What if you could be admitted to the hospital—in your own bedroom? That’s the idea of a health care model called Hospital at Home, which is aimed at elderly patients with diseases such as congestive heart failure, emphysema, urinary tract infections, or pneumonia. According to a new study published in the journal Health Affairs, people receiving this care through the [...]