Performance Improvement 2009. How Did Medicare's Preferred Provider Organization Demonstration Affect Beneficiary Prescription Drug Plan Choice and Participation?


This study evaluated the Medicare Preferred Provider Organization (PPO) demonstration, which ended in 2006. The demonstration sought to expand the types of managed care products to Medicare beneficiaries and test the impact of enhanced payment and risk sharing on the range of options and benefits to beneficiaries.

The demonstration succeeded in expanding plan choices in a wide variety of geographic areas. Although many plans were offered, enrollment and market share under the demonstration was modest. PPO enrollees were similar to other Medicare Advantage plan enrollees. They tended to be healthier than the average beneficiary in the traditional Medicare program. The demonstration was a precursor to the local and regional PPOs established by the Medicare Modernization Act of 2003, and many demonstration plans transitioned to Local PPOs in 2006.

Report Title: Evaluation of the Medicare Preferred Provider Organization Demonstration; Report may be obtained from Federal Contact
Agency Sponsor: CMS-ORDI, Office of Research, Development, and Information
Federal Contact: Noemi Rudolph, 410-786-6662
Performer: Research Triangle Institute
PIC ID: 8966

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"PerformanceImprovement2009.pdf" (pdf, 1.26Mb)

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