Simplifying Medicare Managed Care Offerings Proves to be Tall Order

Workshops and a publication on public accountability and informed purchasing in Medicare managed care

From 1994 to 1999, an expert committee at the National Academy of Sciences–Institute of Medicine (IOM) developed recommendations on how to ensure that Medicare beneficiaries have adequate information and protections when they consider enrolling in managed care plans.

The committee also detailed ways to implement the recommendations developed under the first grant.

Key Recommendations

  • Allow beneficiaries a maximum of choices by giving them access to all plans available in their local market and the option to remain in traditional fee-for-service plans.

  • Require plans to market their services at the same time of year and have the federal government use common definitions for describing plan quality to promote comparability.

  • Develop a Medicare customer service center to explain to beneficiaries their options in Medicare plans.

Key Results

  • In 1998, the IOM held a workshop that focused on developing an information infrastructure for Medicare.

  • In a "letter report" to the Health Care Financing Administration (HCFA), the federal agency that administers Medicare, the committee outlined recommendations for implementing new legislation that authorized HCFA to contract with greater numbers of managed care plans.

    The committee recommended that HCFA conduct further testing and stagger proposed mailings announcing an expansion of the Medicare managed care program.