Managed Medicare and Medicaid Markets

• 1.1 Scope and Objectives of Report
• 1.2 Methodology
• 1.3 Changing World of Medicare/Medicaid Markets

2 Introduction

• 2.1 Managed Care Overview
• 2.2 Health Maintenance Organizations (HMOs)
• 2.3 Preferred Provider Organizations (PPOs)
• 2.4 Other Types of Managed Care Organizations
• 2.4.1 Exclusive Provider Organizations
• 2.4.2 Integrated Provider Organizations/Integrated Delivery Systems
• 2.4.3 Mixed Model HMOs

3 Managed Medicare

• 3.1 Overview
• 3.1.1 Part A: Hospital Insurance
• 3.1.2 Part B: Medical Insurance
• 3.1.3 Part C: Medicare + Choice
• 3.1.4 Other Medicare Supplemental Options: Medigap, Medicare SELECT
• 3.2 Managed Medicare Advantages
• 3.3 Types of Contracts
• 3.3.1 Risk Plans
• 3.3.2 Cost Plans
• 3.3.3 Healthcare Prepayment Plans (HCPPs)
• 3.3.4 Point-of-Service/Out-of-Network (POS/ON) Options
• 3.4 Medicare Costs
• 3.5 Medicare HMOs
• 3.5.1 Enrollment
• 3.5.2 PACE (Program of All Inclusive Care for the Elderly)
• 3.6 Appeals Process

4 Managed Medicaid

• 4.1 Overview
• 4.2 Enrollment Trends
• 4.3 Medicaid Managed Care Plans
• 4.3.1 Commercial MCO
• 4.3.2 Health Insuring Organization
• 4.3.3 Medicaid MCO
• 4.3.4 Prepaid Health Plan
• 4.3.5 Primary Care Case Management
• 4.3.6 HMO Risk Contracts
• 4.3.7 Capitations
• 4.4 State Medicaid
• 4.4.1 State Children’s Health Insurance Program
• 4.5 Medicaid Waivers
• 4.5.1 Section 1915(b)
• 4.5.2 Section 1915(c)
• 4.5.3 Concurrent 1915(b) and 1915(c)
• 4.5.4 Section 1115
• 4.5.5 Innovative 1115 State Medicaid Demonstrations
• 4.6 Medicaid Health Plan Employer Data Information Set

5 Issues and Trends

• 5.1 Legal and Legislative
• 5.2 Low Income and Elderly
• 5.3 Marketing Issues
• 5.4 Consumer and Patient Protection Issues
• 5.5 Cost Containment
• 5.5.1 Medicare Cost Containment
• 5.5.2 Medicaid Cost Containment
• 5.6 Medicare + Choice Program Difficulties
• 5.7 Pharmacy Coverage for Medicare
• 5.8 Medicare Card Competition
• 5.9 U.S. Healthcare System Crisis
• 5.10 Premium Support System
• 5.11 Medicare and Tricare
• 5.12 HMO Marketing Strategies

6 Market Analysis for Managed Medicare and Medicaid

• 6.1 Market Size and Forecast by Premium Revenues
• 6.1.1 Total Market: Medicare and Medicaid
• 6.1.2 Managed Medicare Market
• 6.1.3 Managed Medicaid Market
• 6.2 Current Enrollment by Managed Care Organization
• 6.2.1 Total HMO Enrollment
• 6.2.2 Medicare Enrollment
• 6.2.3 Medicaid Enrollment
• 6.3 Current Market Share by Enrollment
• 6.3.1 Medicare
• 6.3.2 Medicaid

7 Company Profiles

• 7.1 Aetna, Inc.
• 7.2 AMERIGROUP Corp.
• 7.3 Blue Cross Blue Shield Association
• 7.4 CIGNA Corp.
• 7.5 Coventry Health Care, Inc.
• 7.6 Health Net, Inc.
• 7.7 Humana, Inc.
• 7.8 Kaiser Permanente
• 7.9 Oxford Health Plans, Inc.
• 7.10 PacifiCare Health Systems, Inc.
• 7.11 Sierra Health Services, Inc.
• 7.12 UnitedHealth Group
• 7.13 WellPoint Health Networks, Inc.

8 Company Directory