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Medicare's Experience with PPOs and Private Fee-for-Service Plans [PDF]

This publication reviews Medicare's limited experience with preferred provider organizations and private fee-for-service plans. It notes that fewer than 100,000 beneficiaries are now in such plans. The researchers also note concern about feasibility nationally and potentially higher costs.
Marsha Gold, Lori Achman
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Rural enrollment in Medicare advantage is concentrated in private fee-for-service plans.

Rural policy brief, 2007
Enrollment in Medicare Advantage (MA) plans more than doubled in rural areas in 2006, the first year of the MA program. However, rural enrollment remains well below urban enrollment as a percentage of the eligible population. This policy brief provides findings about enrollment in the newly designed MA program in rural and urban areas across the United
Timothy D, McBride, Tanchica L, Terry, Keith J, Mueller   +2 more
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Use of outpatient mental health services over time in a health maintenance organization and fee-for-service plans

American Journal of Psychiatry, 1987
The authors compared the use of outpatient mental health services in a health maintenance organization (HMO) and fee-for-service plans over a 5-year period, using data from a randomized controlled trial. In any given year, enrollees in the HMO and a fee-for-service plan with identical benefits were equally likely to visit a mental health specialist ...
W G, Manning, K B, Wells, B, Benjamin
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Comparing CMS Spending for a Special Needs Plan’s Enrollees with Medicare Fee-for-Service

SSRN Electronic Journal, 2010
The objective of this analysis was to compare the capitation payments that the Centers for Medicare & Medicaid Services (CMS) makes to SCAN for enrollees in its largest SNP with the payments that CMS would have otherwise made to providers if those individuals incurred claims in the FFS program.
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Prepaid plans re-established in a fee-for-service group.

Medical group management, 1984
A negative past experience in contracting with an HMO had soured a small fee-for-service group's taste for this type of organization. A change in management led to an objective evaluation of the situation and, as a result, a renewal of negotiations with the HMO.
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Racial and Ethnic Differences in Receipt of Primary Care Services Between Medicaid Fee-for-Service and Managed Care Plans

Journal of Ambulatory Care Management, 2007
We used a cross-sectional, population-based sample of Medicaid beneficiaries aged 18-64 to determine whether managed care enrollment was associated with reduced racial/ethnic disparities in self-reported access to primary care services compared with fee-for-service.
Hilary K, Seligman, Arpita, Chattopadhyay, Eric, Vittinghoff, Andrew B, Bindman   +3 more
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Choosing Medicare Advantage Plans Versus Traditional Fee-for-Service: Is This Change the Tipping Point?

Professional Case Management, 2019
Beginning in 2019, the Centers for Medicare & Medicaid Services is expanding the definition of “primarily health-related.” Under the new definition, Medicare Advantage Plans allow beneficiaries supplemental benefits if they compensate for physical impairments, diminish the impact of injuries or health conditions, and/or reduce avoidable emergency ...
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Preventive care in managed care and fee-for-service plans: is it cost effective?

Managed care interface, 2003
Lack of coverage, knowledge, and physician guidance, and low socioeconomic status are major barriers to receiving preventive care. Compared with fee-for-service insurance, managed care promotes prevention through more generous coverage, physician incentives, and patient education, and members of MCOs use more preventive services than do members of fee ...
Y Richard, Wang, Mark V, Pauly
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Creating a sustainable physician compensation plan. Serving both fee-for-service and capitated populations.

Medical group management journal, 2001
A large, integrated health system in St. Louis acquired a primary care, health maintenance organization staff model group practice with 55 physicians. Health system leadership positioned the acquired physician group to diversify and expand its fee-for-service patient base to increase revenue and support the expansive fixed cost structure of the health ...
J A, Deane, S R, Nussbaum
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Family physicians and the future of fee-for-service payment plans.

The Journal of family practice, 1986
The mechanisms by which health care providers in the United States are reimbursed for their services are undergoing dynamic and rapid changes. Traditional fee-for-service payment schemes as the predominant reimbursement methods are declining and are being supplanted by a plethora of different schemes that incorporate prepayment as the mode of ...
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