It wasn't long ago that Medicare held a special lure for HMOs, which saw the government's foray into managed care as a lucrative opportunity. But if a PacifiCare decision last month is any indication, Medicare is no longer the golden egg.
The company's five-year strategic plan calls for aggressive expansion in the commercial market — PacifiCare wants to boost its employer-based business 47 percent — but no such grandiosity is slated for the Medicare side. PacifiCare's Secure Horizons HMO, which enrolls more than 1 of every 6 people in Medicare+Choice, is the biggest player in managed Medicare. But with tighter capitation rates squeezing HMOs, PacifiCare is thinking about balancing its revenue stream. Almost $3 of every $5 PacifiCare collects is from Medicare.
PacifiCare's plan puts an exclamation point on HMOs' continuing disenchantment with Medicare. Many of PacifiCare's competitors and other plans have left lower-paying counties or dropped out of Medicare altogether in the last year, disrupting coverage for more than 700,000 elderly.
Paul Lendner ist ein praktizierender Experte im Bereich Gesundheit, Medizin und Fitness. Er schreibt bereits seit über 5 Jahren für das Managed Care Mag. Mit seinen Artikeln, die einen einzigartigen Expertenstatus nachweisen, liefert er unseren Lesern nicht nur Mehrwert, sondern auch Hilfestellung bei ihren Problemen.