PolicyArchive is a comprehensive digital library of public policy research containing over 30,000 documents. Join today and upload your own research and customize your user experience.
Publication Date: March 2008 View Publication
Publisher: IBM Center for The Business of Government
Special Collection: Presidential Advisory
Keywords: Presidential transition; Healthcare industry; Medicare
Coverage: United States
Since 1998, large numbers of HMOs have exited Medicare's coordinated care plan Medicare + Choice (now called Medicare Advantage), involuntarily un-enrolling hundreds of thousands of Medicare beneficiaries. These exits are due to the fact government-specified pricing for medical services causes Medicare to pay too much for some services and too little for others. Program payments to HMOs rarely reflect the variations in costs in different geographic areas.
The system needs a better way of determining the amount to be reimbursed. The system of setting M+C payments requires the Center for Medicare and Medicaid Services (CMS) to set HMO payments that accurately reflect the costs in the local market for each county of the United States. An alternative system is competitive bidding.