Markets at Risk— Current and Future Challenges in a Managed Care Marketplace. B. Public Sector Trends


1. Medicare. To what extent will plan participation shrink back to only the high AAPCC markets characteristic of risk contracting in the early 1990s? What type of plans will remain and what kind of provider network arrangements will they have? What factors are associated with more favorable benefits or premium arrangements in surviving plans?

2. Medicaid. How dependent will states become on Medicaid-dominated plans in order to sustain full risk models? How successful are non-risk or limited risk models in preserving or expanding Medicaid managed care in states that cannot or choose not to do full risk arrangements? To what extent can conventional managed care products that employ cost sharing be employed or adapted for Medicaid- eligible populations?