(1985) found that among Medicare risk contract
The one strictly rural HMO that has a Medicare risk contract
indicated that its sole purpose is to provide quality care to the rural Colorado area in which it is located, including Medicare beneficiaries.
In contrast exclusively rural HMOs, including the one rural HMO that has a Medicare risk contract
, exhibited a strong service commitment to the rural counties in their service areas.
This group has become commonly referred to as the "Medicare risk segment." A Medicare Risk contract
involves an HMO that is capitated by HCFA for Part A and Part B services, at 95% of the calculated average fee-for-service costs of a region.
This article also shows that AAPCC rates and provider network considerations are important factors in decisions made by a number of HMOs to exclude rural counties in their commercial service areas from their Medicare risk contract
This HMO reported substantial financial losses and terminated its Medicare risk contract
in December 1985.
Although more complex behavioral models could be postulated, HMOs are simply assumed to compare the utilities arising from their expected enrollment, profit, and risk for the discrete alternatives of entering into a Medicare risk contract
versus the status quo.
Although enrollment in such plans is small, it is growing and appears to be affecting the composition of the Medicare risk contract
"Recent Determinants of New Entry of HMOs into a Medicare Risk Contract
." Inquiry 36 (1): 78-89.
In 1995, a 300-bed community hospital in an affluent suburb north of Chicago, entered into its first Medicare risk contract
. In the early stages, the program attracted relatively low-risk seniors.
Firms are positively influenced by the payment assigned to counties (Adamache and Rossiter 1986; Porell and Tompkins 1993; Porell and Wallack 1990; Serrato, Brown, and Bergeron 1995); characteristics of the Medicare population in the area such as income status, proportion disabled, and size of the elderly population (Adamache and Rossiter 1986; Porell and Tompkins 1993; Porell and Wallack 1990; Serrato, Brown, and Bergeron 1995); the size of commercial risk plan enrollment (Welch 1996); the firm's financial performance (Serrato, Brown, and Bergeron 1995); and whether the Medicare risk contract
is a regional component of the firm's products (Porell and Tompkins 1993).
Competitive Medical Plan (CMP)--Is not a federally-qualified HMO but which meets Medicare statutory requirements for entering into a Medicare risk contract