does not guarantee that they will be referred to such providers. It also may be useful for prospective enrollees to understand how HMOs pay their physicians in order to evaluate disincentives to provide needed care (Stocker, 1995), although this information might be difficult to convey in a simple and comprehensible way.

It is not entirely clear what kind of information Medicare beneficiaries want in order to choose among managed care plans and other options. Research under way at NCQA to learn from focus groups and other sources what plan information consumers would like. Some Medicare beneficiaries not enrolled in HMOs who participated in two recent focus group studies were skeptical about consumer satisfaction ratings and indicated that this information would not be useful to them in choosing among plans unless the reports included specific questions of interest to them, information on who responded, and the sponsoring organization (Frederick/Schneiders, Inc., 1995; Gibbs, 1995). Medicare consumers appear similar to other prospective health plan enrollees recently surveyed by GAO who reported wanting more information on health plan outcomes and quality but expressed skepticism about reliability and validity of plan-generated "report cards" (U.S. General Accounting Office, 1995b).

Counseling and Advocacy Services

Even with better-trained and motivated plan sales staff and improved marketing and enrollment materials, prospective health plan enrollees may need the assistance of independent counselors to answer questions about the nature of managed care and specific plans. Although some people may be misled by plan marketing, others doubt that a plan's information will be objective and would value access to an outside source of information. Such assistance is provided by information, counseling, and assistance (ICA) programs funded by HCFA. Omnibus Budget Reconciliation Act 1990 provided federal funding for ICA programs (operating through a combination of paid staff and volunteer counselors at the state and local levels) to assist Medicare beneficiaries with obtaining appropriate public and private health insurance coverage (McCormack et al., 1994). Participants in a recent set of Medicare focus groups said that they



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