Improving the Medicare Market: Adding Choice and Protections

TABLE 2-4 Medicare Legislation Report Card: The Clinton Administration's Proposal

Issue	Government Knows Best	Leave It to the Market	Government Policy Is to Correct Market Deficiencies
Benefits/plan type	X
Licensing	X
Enrollment			X
Consumer
Information	X
Purchasing style	X
Plan payments	X
Communications/ education strategy		X
Chronic care/ disclosure		X
Total (%)	50	25	25

vice, be fiscally solvent, and adhere to internal as well as external quality assurance requirements. Similarly, payments to plans are not based on competitive bidding or contracting, but continue to use government-set payments, based on modifications to the current AAPCC system and, in the case of the congressional legislation, based on further national per capita growth limits.⁴⁶

With regard to purchasing style, both proposals support the FEHBP approach in which the federal government offers all plans that meet the conditions of participation and do not permit more selective and active purchasing based on performance, a strategy used by many employers to ensure accountability and value.

Both proposals would generally let the market prevail in the range of plan choices to be offered to beneficiaries. The Clinton administration's proposal, however, would not allow medical

⁴⁶	HCFA is currently testing a number of competitive pricing approaches under its demonstration authority.

Table of Contents

Front Matter R1-R16

Executive Summary 1-10

1 Overview 11-38

2 Symposium Summary 39-79

3 Findings and Reccomendations 80-110

References 111-115

References Consulted 116-120

A Additional Commentary Regarding Choice Facilitating Organizations 121-124

B Invitational Symposium Agenda 125-130

C Symposium Participants 131-135

D Commissioned Papers 136-R0

E The Structure and Accountability for Medicare Health Plans: Government, the Market, and Professionalism 137-158

F Best Practices for Structuring and Facilitating Consumer Choice of Health Plans 159-194

G Medicare Managed Care: Issues for Vulnerable Populations 195-235

H Reaching and Educating Medicare Benificiaries About Choice 236-269

I What Information Do Consumers Want and Need: What Do We Know About How They Judge Quality and Accountability? 270-289

J Medicare Managed Care: Protecting Consumers and Enhancing Satisfaction 290-325

K Medicare Managed Care: Current Requirements and Practices to Ensure Accountability 326-337

L What Should Be the Basic Ground Rules for Plans Being Able to Participate in the Medicare Managed Care Market? Case Study: The California Public Employees' Retirement System 338-352

Index 353-368