GERIATRICS IN MANAGED CARE: Managed Care for Older People: A Primer for the Geriatrician

Abstract

Managed care for older people is growing at a very rapid rate. Many geriatricians and primary care providers are interested in this area but have limited sources of information to guide their decision-making about whether to participate in these programs. This review provides a basic overview of managed care for older people, including plan types and roles that geriatricians may choose in participating in these programs. Risk and value are central concepts that impact managed care of this population. Several changes in Medicare Managed Care have occurred with the passage by Congress of the Balanced Budget Act of 1997. Geriatricians are strongly encouraged to participate in managed care as it offers the potential for improved models of care delivery for older adults.

Streamlining assessments and treatments for geriatric mental health in medical rehabilitation.

“…Many changes have occurred in geriatric rehabilitation since the Balanced Budget Act of 1997, which has resulted in greater emphasis on managed care issues. Managed care can be defined as provision of health care services within a structured network, in which providers manage and provide high-quality cost-effective health care (Reed & Hepburn, 1999). Within managed care, risk is defined as financial gains or loss for services delivered.…”

Groups or teams in health care: finding the best fit

“…Internationally, policy makers are embracing and promoting the concept of team as the intra‐organizational vehicle for the future [24]. The Scottish Executive Health Department white paper [25] attests that ‘healthcare will best be delivered when the different parts of the health system work in partnership as teams of professionals and with patients’.…”

“…Not only do the nature of the task, the preparation of the team and the location of the team affect teamwork, current models for financing health care can act as both incentives and disincentives [24]. Fee-for-service, for example, provides no infrastructure funding to support a team, whereas capitation and managed care arrangements usually provide incentives for team work.…”

Practical Geriatrics: Medicare Managed Mental Health Care: A Looming Crisis

“…The confusing array of Medicare+Choice options includes health maintenance organizations, preferred provider organizations, provider sponsored organizations, religious fraternal benefit plans, private fee-for-service plans, and point-of-service plans (2). The confusing array of Medicare+Choice options includes health maintenance organizations, preferred provider organizations, provider sponsored organizations, religious fraternal benefit plans, private fee-for-service plans, and point-of-service plans (2).…”