1/10/2024 0 Comments Hmo seamless definition![]() ![]() Medicare and Medicaid have lagged substantially behind the private sector during this transition and therefore represent the “last frontier” of untapped markets for the managed-care industry. The majority of privately insured individuals-some 65 percent-are already enrolled in some form of managed-care plan, with double-digit annual increases in managed-care enrollment. In all likelihood, indemnity products will represent only about 10 percent of the insurance market within the next 5 years. Today, the dust of the first stage of the managed-care revolution-the struggle between capitation and fee-for-service payment methods-is settling. HCFA's efforts to develop these new methods of quality and performance measurement are being undertaken in partnership with other purchasers, the managed-care industry, States, and other public and private organizations.įor the last 20 years, America's health care system has been embroiled in a revolution of industrialization driven by spiraling costs. New methods of assessing quality of care and outcomes in managed care will have their roots in data on how health plans are responding to the needs of beneficiaries in patient encounters. There is wide agreement that current methods of monitoring the quality of care provided by Medicare and Medicaid managed-care organizations (MCOs) are antiquated and cumbersome. As part of its Strategic Plan and as the Nation's largest managed-care purchaser, HCFA is working to promote improved quality of care, responsiveness, and outcomes for Medicare and Medicaid beneficiaries in managed-care settings. ![]()
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