HCFA said it will introduce initiatives involving the ways HMOs are judged on quality and reimbursed for care as part of a reorganization of its managed-care operations.
Gail Drapala, director of HCFA's Office of Prepaid Health Care Operations and Oversight, said the agency will reorganize to create a new Office of Managed Care. It will combine Medicare and Medicaid managed-care functions as well as federal HMO qualification activities.
Ms. Drapala, who will become deputy director of the new office, said Bruce Vladeck, HCFA's administrator, wanted to create "a critical mass" that would stimulate needed reforms involving managed care. About 2.6 million elderly and another 5 million indigent people are enrolled in managed-care plans.
She told managed-care executives attending a conference last week in Seattle that they should consider the reorganization as an indication of HCFA's continued commitment to managed care. Remarks attributed to Mr. Vladeck last year questioning HMO savings weren't intended to signal a lack of interest by HCFA in devising new ways to boost enrollment in federally sponsored managed-care programs, she said (Feb. 14, p. 82).
Ms. Drapala said HCFA wants to find ways to improve the way it gauges the quality of HMOs. A pilot program for Medicaid known as the Quality Assurance Reform Initiative is about to begin in Ohio, Minnesota and Washington. HCFA hopes the project will help create "one coherent document" for rating Medicare and Medicaid contractors.
She said Mr. Vladeck also has promised changes in the method the government uses to compute reimbursement for Medicare and Medicaid HMOs. HCFA wants to move away from the current fee-for-service-based formula. HMOs have complained for years that the formula unfairly penalizes HMOs operating in areas with high managed-care penetration. HMOs have until July 1 to submit proposals for overhauling the reimbursement methodology, she said.