States cautious of jumping into Medicaid managed care

Article Abstract:

State Medicaid officials estimate that about 33% of Medicaid recipients have enrolled in health maintenance organizations and similar managed care programs, as of summer 1996. The Kaiser Family Foundation, policy makers and public health officials warn states to proceed slowly and beware of the possibility of fraud and abuse. Also, clinics that provide medical care to the indigent and the uninsured may suffer from the withdrawal of Medicaid support.

Medicaid, Administration of Public Health Programs, Management, Evaluation, Managed care plans (Medical care)

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Can HMOs afford to open door to shut-out specialists?

Article Abstract:

A study sponsored by the Patient Access to Specialty Care Coalition found that extra co-insurance and deductibles would allow health maintenance organization (HMO) members to obtain out-of-network care. Point-of-service options have been used for out-of-network care access by HMOs, but many of the HMOs still believe the option is too costly. Specialists want Congress to legislate out-of-network care coverage.

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HMO growth tied to consumer service

Article Abstract:

The results of a CareData Reports survey reveal a wide variation in HMOs' customer satisfaction ratings. HMOs generally received high ratings for care-quality and access to providers, but lower and more varied ratings for customer service categories such as 'concern shown for well-being.' CareData president Tod Cooperman expects HMOs to try to differentiate themselves by emphasizing customer service.

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