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Managed Care

Last Updated: 04-03-2024

The growth of managed care over the last several years has changed fundamental aspects of the Medicare and Medicaid programs. This significant shift transformed how the government pays for and covers health care for approximately 100 million enrollees.

During 2023, 54 percent of people in Medicare received their care through a Medicare Advantage plan.   During 2023, the government spent an estimated $454 billion.  Medicaid Managed Care has experience similar growth.  Currently, 81% of Medicaid beneficiaries receive at least one component of their care through managed care.  The federal match for Medicaid managed care was $254 billion in 2021.

Strategic Plan

Download the Managed Care Strategic Plan

The OIG has designated oversight of managed care as a priority area. OIG has developed a strategy to align its audits, evaluations, investigations, and enforcement of managed care. The HHS-OIG Strategic Plan for Oversight of Managed Care for Medicare and Medicaid has three goals:

  1. Promote access to care for people enrolled in managed care
  2. Provide comprehensive financial oversight
  3. Promote data accuracy and encourage data-driven decisions

OIG developed the managed care life cycle to guide oversight and enforcement work. The life cycle of managed care is fourfold: plan establishment and contracting, enrollment, payment, and the provision of services. Each stage of this life cycle raises different risks and vulnerabilities.

Life cycle diagram