Medicare

Private-Sector and Federal Efforts to Assess Health Care Quality Gao ID: T-HEHS-96-215 September 19, 1996

The Health Care Financing Administration (HCFA) now estimates that 4.3 million Medicare beneficiaries are enrolled in health maintenance organizations (HMO). Enrollment is believed to be growing at a rate of 100,000 new members per month. This testimony discusses ways to ensure that quality care is provided to the Medicare beneficiaries joining these HMOs. HCFA, which runs Medicare, finds the potential cost savings associated with managed care attractive. Concerns have been raised, however, that the cost control strategies employed by HMOs could undermine the quality of care. This testimony discusses (1) quality assessment methods used by large corporate purchasers of health insurance from HMOs, (2) quality assessment methods used by HCFA in administering the Medicare HMO program, (3) quality assessment methods HCFA plans for the future, and (4) what both corporate purchasers and HCFA are doing to share information about quality with employees and Medicare beneficiaries.



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