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Private-fee-for-service (PFFS) is the hottest — and most controversial — product in Medicare. Membership in the product has grown by leaps and bounds in recent years as plan sponsors realized the advantages of a product that doesn’t require contracting with a network of providers, and that can be put together and approved for startup quickly. But problems have arisen too, as many providers won't accept PFFS patients because of concerns about both payment levels and relative slowness of payment. That in turn has caused a flurry of complaints — and new regulatory scrutiny. Medicare Private-Fee-for-Service: Health Plan Strategies for a Booming but Controversial Product is designed to help health plans and their partners design PFFS products that meet beneficiaries’ and providers’ — as well as their own — goals while avoiding investigations and enforcement actions by regulatory authorities. It includes an edited transcript of a well-received April 19, 2007, AIS audioconference, as well as presenters’ slide presentations and AIS articles on the topic. In this report, two of the nation's top Medicare managed care experts cover topics including:
Learn strategies that will help you seize the current and future opportunities in PFFS … and avoid the pitfalls ahead. Order your copy of Medicare Private-Fee-for-Service: Health Plan Strategies for a Booming but Controversial Product today!
Introduction Transcript of AIS Audioconference
Materials Supplied by John Gorman and Jean LeMasurier Selected Articles From AIS Publications
This book was compiled by the editorial staff of AIS. The speakers at the April 19, 2007, audioconference were: JOHN GORMAN is president and CEO of Gorman Health Group, LLC, the leading consulting firm specializing in Medicare managed care and Part D. Before starting his company in 1996, Mr. Gorman served as assistant to the director of HCFA's Office of Managed Care under two directors. Prior to that, he was staff director to U.S. Rep. John Conyers Jr., then chairman of the House Government Operations Committee. Mr. Gorman specializes in strategic planning and business development for the health care industry, with particular emphasis on federal programs and regulation. JEAN LeMASURIER is director, Employer Group Practice, at Gorman Health Group, LLC. She joined GHG after a 30-year career with CMS and its predecessor, most recently as senior advisor for the Employer Policy and Operations Group in CMS's Center for Beneficiary Choices. In that role, Ms. LeMasurier provided leadership on policy and operational issues related to implementation of the 2003 Medicare reform law. Before that, she spent six years as the acting director/deputy director of the Health Plan Benefits Group in the Center for Beneficiary Choices, responsible for purchasing and regulatory oversight of Medicare managed care services.
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