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The Executive Guide to Medicare Managed Care -- Table of Contents

Introduction

Chapter 1: The Growth of Medicare Managed Care
Payors Look to Managed Care To Cover Healthcare Costs for Seniors, p. 11
Largest Medicare Managed Care Markets Identified, p. 12
Emerging Medicare Risk Enrollment Markets, p. 14
Medicare Managed Care Growing Inconsistently, p. 15
Medicare HMO Enrollment Expected To Double, p. 16
Several Factors Influence Medicare HMO Market Penetration, p. 18

Chapter 2: Trends in Managed Care for Seniors
The Implications of Medicare Managed Care Growth, p. 23
Only 4 Percent of Medicare HMO Enrollees Switch Back to Fee-for-Service Option, p. 25
How Managed Care's Presence Affects Fee-For-Service Costs, p. 25
The "Revolving Door" in Enrollment for Medicare HMOs, p. 27
Seniors Value Their Right To Choose Own Doctor, p. 29

Chapter 3: Assessing The Quality of Senior Care in Managed Care
Feds To Increase Accountability in Medicare Managed Care, p. 33
Social/HMO Keeps Elderly in Community Longer, p. 34
Study Questions Managed Care's Ability To Care for Frail Seniors, p. 36
Retirees Rate Their Managed Care Plans, p. 37
Providing Services to People With Chronic Conditions, p. 40
Chronic Care in Medicare and Medicaid Reform, p. 41
Associations To Develop a Model for Alzheimer's Care in Managed Care Environment, p. 43

Chapter 4: How To Position Senior Services for Managed Care
How To Succeed in the Medicare Managed Care Market, p.41
Positioning Senior Services for Managed Care, p.42
Look for Gaps in Services To Position for Managed Care, p. 43
Flexibility, Assessment Needed To Position for Managed Care, p. 44
Begin Your Voyage Into Managed Care by Contracting With Physician Groups, p. 45
Senior Health Partnership Helps Hospital Position for Managed Care, p. 46

Chapter 5: Forge Partnerships for Managed Care
Hospital and HMO Affiliate To Improve Services for Elderly, p. 57
Innovative Managed Healthcare Approaches, p. 58
Providers Form Networks To Position for Managed Care, p. 60
Four Adult Day Programs Form Network To Seize Opportunities in Managed Care, p. 63
Link Up With Provider Networks, p. 64
How Four Senior Services Providers Use Management Services Organization, p. 66
Evaluate Relationships, CreateShared Goals for Successful Networks, p. 68

Chapter 6: Quality and Outcomes Measurement
Quality Assurance Needed as More Medicare Beneficiaries Move Into Managed Care, p. 73
Quality Assurance of Medicare HMOs Not Up To Par, p. 73
A Six-Point Checklist for How You Can Start Outcome Measurement Initiatives, p. 75
Top Tips To Help You Measure Outcomes and Performance, p. 77

Chapter 7: Managed Care Strategies To Attract and Retain Seniors
Member Retention Affects More Than Balance Sheets, p. 83
Three Reasons for Managed Medicare Disenrollment Dissatisfaction, p. 84
Avoid Medicare Managed Care Disenrollment Through Collaborative Effort, p. 87
Managed Care and Reduce Utilization To Succeed in Medicare, p. 89
Point-of-Service Product Entices More Seniors Into Managed Care, p. 93
Health Plan Incorporates "Personal Touch," p. 94
Managed Care Plan for Seniors on the Move, p. 95
Innovative Marketing Strategies, p. 96
AARP Proposes Licensing Agreements with HMOs, p. 99

Chapter 8: Medicare Managed Care Regulations and Legislation
Provisions in the Balanced Budget Act, p. 103
Marketing Guidelines for Medicare MCOs and Contracted Providers, p. 104
HHS Bans "Gag Laws," p. 107
HCFA Will Require Performance Data From Medicare Risk and Cost Contractors, p. 107
HCFA Demonstration Project Expands Choices in Medicare Managed Care, p. 108
Implications of Medicare Reform on the Healthcare Market, p. 110

Chapter 9: Provider-Sponsored Organizations
Some Providers May Find it Easy To Create PSOs, p. 115
HHS To Develop Rules and Guidelines for PSOs as Part of Balanced Budget Act, p. 116
HCFA Releases PSO Solvency Standards, p. 119
What To Expect From the PSO Application Process, p. 124
Quality Requirements for PSOs, p. 128
Assessment of Strategic Issues Can Facilitate PSO Formation, p. 130
When To "Go PSO," p. 132
How To Overcome Challenges Of PSO Medicare+Choice Enrollment, p. 135
How To Create A Competitive Marketing Plan as a PSO, p. 138
Practices of Successful PSOs, p. 140

Chapter 10: Forecasts for the Medicare Managed Care Market
Improvements Needed for Medicare Risk Program, p. 145
What's in Store for Medicare Managed Care, p. 146
What To Expect From Medicare Manged Care, p. 148
Managed Medicare/Medicaid Markets Expected To Post 100 Percent Enrollment Increases, p. 150

Appendix I: Medicare+Choice Program Provisions From the Balanced Budget Act, p. 153

Appendix II: Managed Care Resources, p. 187