Status of the Medicare PPO Demonstration Early Implementation Experience of: CAPP CARE, Family Health Plan Healthlink Caremark.

摘要

The report describes in detail the nature of the pre-implementation experience of four of the five Preferred Provider Organizations (PPO) in the Medicare Physician PPO demonstration. The fifth, BCBS/AZ, was described and assessed in an earlier report-Nelson and others 1990. The description of each PPO includes: Design of the PPO's benefit package, including incentives to enroll and to use network providers; Marketing approaches; Criteria and process for selecting network providers; Utilization management procedures; Quality assurance procedures. The report also gives a preliminary assessment of the early implementation experience of the demonstration as a whole.