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Date: Friday, Dec. 27, 1996 FOR IMMEDIATE RELEASE Contact: HCFA Press Office (202) 690-6145
The Medicare Choices demonstration is designed to give beneficiaries expanded choices among types of managed care plans and to test new ways to pay for managed care. Beginning January 1, beneficiaries in the four areas can choose from among the newer types of managed care plans now available under Medicare.
The plans include four provider sponsored networks (PSNs), one preferred provider organization (PPO), and a "triple option" hybrid plan. The hybrid plan lets beneficiaries use a "gatekeeper" physician in the plan, see other providers in the plan's network without going through the gatekeeper, or go outside the network. In all six plans, payments by Medicare will be adjusted according to the health status of beneficiaries, instead of only demographic factors.
"President Clinton is committed to giving America's seniors high quality health care and increased choices. Quality and choice: these will be the hallmark of Medicare for the Clinton Administration as we move toward the 21st century," said Health and Human Services Secretary Donna E. Shalala. "The Clinton Administration is committed to providing seniors quality and choice in their health care plans. These innovative managed care plans are expanding the options available to our beneficiaries, and expanding the reach of Medicare managed care to beneficiaries in rural areas who traditionally have had the fewest managed care options," said HCFA Administrator Bruce C. Vladeck.
Beneficiaries around the country currently can obtain managed care though more than 300 health maintenance organizations that participate in Medicare. Choices demonstration sites are in targeted market areas that were chosen because they currently have limited Medicare enrollment in managed care. An additional 13 sites are expected to begin enrollment in 1997 in Florida, California, Georgia, Illinois, Louisiana, Montana, New York, Ohio, Pennsylvania and Texas.
The number of Medicare beneficiaries voluntarily choosing managed care has been growing by 80,000 each month. Nearly five million of Medicare's 38 million beneficiaries have chosen to join managed care plans.
The first six Medicare Choices demonstration sites are:
Florida Hospital Healthcare System, Orlando, Fla. -- PSN
Health Plans of Pennsylvania, (Crozer-Keystone Health System), Philadelphia, Pa. -- PSN
Health Partners of Philadelphia, Philadelphia, Pa. -- PSN
Independence Blue Cross, Philadelphia, Pa. -- PPO
Memorial Sisters of Charity Health Network, Houston, Texas -- PSN
QualChoice of Virginia, Charlottesville, Va. -- "Triple option" hybrid
A description of the demonstration sites is attached.
Houston, Texas: The Memorial Sisters of Charity Health Network is a provider sponsored network sponsored by the Memorial Healthcare System and the Sisters of Charity of the Incarnate Word. It will offer a point-of-service network in Houston and surrounding counties. In the first year, the plan will be paid under standard Medicare risk plan payment methods while it keeps track of all services provided to its Medicare beneficiaries. In the second year, payments will be prospectively adjusted for beneficiaries health status, based on the care they receive in the first year.
Philadelphia, Pa.: The Health Plans of Pennsylvania (Crozer-Keystone Health System) is a provider sponsored network based in Delaware County. It will offer a point-of-service network in the Greater Philadelphia area. In the first year, the plan will be paid under standard Medicare risk plan payment methods while it keeps track of all services provided to its Medicare beneficiaries. In the second year, payments will be prospectively adjusted for beneficiaries health status, based on the care they receive in the first year.
Health Partners of Philadelphia is a non-profit entity owned by seven teaching hospitals. It will offer a network of providers in the Greater Philadelphia area. In the first year, the plan will be paid under standard Medicare risk plan payment methods while it keeps track of all services provided to its Medicare beneficiaries. In the second year, payments will be prospectively adjusted for beneficiaries health status, based on the care they receive in the first year.
Independence Blue Cross will offer its PPO network plan to Medicare beneficiaries in five counties in the Greater Philadelphia area. In the first year, the plan will be paid under the standard Medicare risk plan payment method while it keeps track of all services provided to its Medicare beneficiaries. In the second year, payments will be prospectively adjusted for beneficiaries health status, based on the care they receive in the first year.
Rural Southern Virginia: QualChoice of Virginia is an HMO founded in 1994 by the University of Virginia and the University of Virginia Health Services Foundation. It will offer a triple-option point-of-service network to be offered to Medicare beneficiaries in Charlottesville and seven predominately rural counties in central and western Virginia. Beneficiaries can use either a "gatekeeper" physician in the plan, see other providers in the plan without going through a gatekeeper, or go outside the network. In the first year, the plan will be paid under the standard Medicare risk plan payment method while it keeps track of all services provided to its Medicare beneficiaries. In the second year, payments will be prospectively adjusted for beneficiaries health status, based on the care they receive in the first year.