Although Medicare has been studying post-retirement alternatives for nearly a decade, many issues remain to be addressed. In this section (1), we highlight HCFA`s demonstration programs for the extension and refinement of risk contracts, (2) describe ongoing research and will provide answers to many of these questions; and (3) discuss the direction of future policy in the middle of the Medicare program, while highlighting several issues related to these new trends. If the beneficiary is enrolled in Medicare`s benefit plan or managed care plan, but as claims are filed with Medicare insurance instead of submitting them to the Medicare Advantage plan, the rights are rejected in the form of CO 24 – the costs are covered by a head administration contract or guaranteed health care plan contracts were created with the aim of improving incentives for efficiency, cost control. preventive health care. Since most people involved in a health plan will not use the services within a month, agreements on the use of head administrations should, of course, compensate high-frequency users with plan members who receive little or no health care each month. Since the physician, hospital or health care system is responsible, regardless of the health costs of the registered member, the guarantee theoretically motivates the health care provider to focus on health screenings (mammograms, pap smears, PSA tests), vaccinations, prenatal care and other preventive care that can help keep members healthy, with less dependence on expensive specialists. A contract with Kopf is a health plan that allows the payment of a flat fee for each patient it covers. Under a rental agreement, an HMO or a managed care organization pays a fixed amount of money to its members to the health care provider. Capitated contracts are also called head, helmet and managed care contracts. This article examines the history of capitation in the Medicare program and examines the questions and research findings related to Medicare Capitation.
Specific issues related to corporate dedication and the results of research include the feasibility and extent of the health care organization`s involvement in Medicare; Plan marketing; The electoral behaviour of beneficiaries; Quality of care use and cost of services. In addition, areas requiring further study and the potential for expansion of capitation under Medicare will be examined. The HCFA Research and Demonstration Office has encouraged a series of studies on capitation impact issues, which will provide information to definitively determine the type of head/head policy for the Medicare program. It is interesting to note that the Office of the President of Homeland Policy recommended that the Department of Health and Human Services (DHHS) test and implement a one-on-one system that extends the current Medicare HMO program to allow payments to other insurers and other medical groups. Traditionally, payers have reimbursed health care providers for the costs of the services provided or the volume of services provided. But new types of health plans are moving from volume payment to value payment – taking into account costs, consumer health outcomes and consumer experience – with top performance rates based on the most „advanced“ performance on the scale. Much of the current controversy over capitation and the Medicare program is about defining the appropriate payment method. The amount of payments must be high enough to attract HMO`s to the Medicare market. At the same time, the methodology must reflect the differences between the expected expenditures of beneficiaries. Otherwise, medicare, if it makes the application of biased selection, may result in lower costs than it would have been if the beneficiaries had remained within the pricing parameters.