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PubMed1993

Has this doctor-governor found the key to health reform?. Interview by Berkeley Rice.

Under the leadership of internist Howard Dean, the nation's only physician-governor, Vermont is adopting a comprehensive health-care plan that will revolutionize the way the state's doctors practice medicine. As Vermont goes, so may the nation, for Dean is one of the key advisers to the Clinton administration on health-care reform. But if the Vermont plan serves as a model for the rest of the country, many doctors may find it a better pill to swallow. Among other things, it could mean that nearly all the state's physicians will, in effect, participate in a state-run HMO and be subject to global fees and budgets that will also cover hospitals (see opposite page). While the plan's specific provisions are still being debated, Dean's views have spread to other states and to the Clinton administration through his role as co-chairman of the National Governor's Association task force on health care. In a recent interview with Senior Associate Editor Berkeley Rice in the governor's office in Montpelier, Dean discussed Vermont's new health plan, its importance as a model for other states, and his unique perspective as physician-governor.

Cost Control↗
PubMed1983

An apple a day ...

Explore the source record for details and available documents.

Deductibles and Coinsurance↗
PubMedDate not supplied

Cost sharing in corporate benefit plans: the cases of Gulf Oil and DuPont.

In 1983 the Health Systems Management Center of Case Western Reserve University contracted with the Business Roundtable Health Initiatives Task Force to use BRT's survey of members as a guide to the top firms who had taken action regarding health care costs and more importantly, had also evaluated the cost implication of that action. The mandate was to draw together representative case studies on seven firms who met those criteria for use in BRT educational seminars and elsewhere. These cases may provide important insight for other companies which are contemplating action regarding their health care costs. They should also lead to further research on alternative actions available and the means of evaluation that should be considered. Most importantly they may provide some methodology for top management to choose among proposals for attacking this burgeoning corporate cost. Two of the case studies selected as representative were DuPont Corporation and Gulf Oil Corporation. Both DuPont and Gulf Oil, increased the level of cost sharing through copayments and deductibles and improved administrative efficiency by consolidating multiple plans into a limited set of options available to all employees nationally under an administrator chosen by competitive bid. Both plans were evaluated by projecting experience that might be expected under the former arrangements with consideration of biases due to adverse selection among options. This was compared with actual experience to reveal substantial savings in each case which should be replicable elsewhere under similar circumstances. Unfortunately, lack of suitable controls and comparisons limits the confidence in the precision of these evaluations.

Deductibles and Coinsurance↗
PubMed1987

A perspective: the Medicare secondary payer program.

Providers have become accustomed to billing Medicare beneficiaries. But because of a series of changes in the laws, there are some circumstances where Medicare becomes the secondary payer of claims. Terefore, HCFA has begun a concerted effort to manage claims processing, trying to identify secondary payer situations.

Deductibles and Coinsurance↗
PubMed1988

Providers assume responsibility for overpayment in liability cases.

The Health Care Financing Administration (HCFA) has informed hospitals that they can no longer bill or file liens against liability proceeds involving Medicare beneficiaries. HCFA also told providers that before they request conditional payment from Medicare, they must provide their fiscal intermediaries with complete information about any payments received from primary payers, or else reimburse Medicare for any overpayments. This article examines situations in which providers can be held liable for Medicare overpayment and explains how to lessen the facility's risk.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1988

Medicare program; employers and duplicative Medicare benefits--HCFA. Notice.

This notice announces the national average actuarial value of additional Medicare Part A benefits available in 1989 as a result of the Medicare Catastrophic Coverage Act of 1988. Employers are required to examine the extent to which health benefits they provide to employees and retired former employees entitled to Medicare (including coverage for employees' and retired former employees' dependents entitled to Medicare) duplicate the new Part A and Part B benefits. If the duplicative benefits have a national average actuarial value of at least 50 percent of the value of the new Medicare benefits, the employer must offer a refund, additional benefits, or some combination thereof. In computing the actuarial values of the duplicative benefits, employers have the option of using national average actuarial values we establish or calculating the actuarial value based on guidelines we establish. This notice contains both the national actuarial values we have determined and the guidelines for employers to use.

Actuarial Analysis↗
PubMed1988

Innovative concepts in public-private coordination of benefits for retirees.

Benefits--in the broadest and most literal sense of the word--can be coordinated between Medicare and employer group health plans. What that may entail, however, ranges from (1) researching complementary plans' effect on Medicare utilization and costs; to (2) incorporating those findings into rate setting for the Medicare capitation payment that would be administered by the EGHPs; to (3) some potential cost-containing redesign of complementary plans that would be acceptable to employees/retirees and their unions and would involve improvements in information provided to consumers; to (4) some consideration given to allowing savings achieved through capitation to become part of a trust that would prefund the EGHP retiree plan.

Aged↗