Medicare Advantage
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PNAS: Randomized trial shows healthcare payment reform has equal-sized spillover effects on patients not targeted by reform
Read more: PNAS: Randomized trial shows healthcare payment reform has equal-sized spillover effects on patients not targeted by reformAbstract: Changes in the way health insurers pay healthcare providers may not only directly affect the insurer’s patients but may also affect patients covered by other insurers. We provide evidence of such spillovers in the context of a nationwide Medicare bundled payment reform that was implemented in some areas of the country but not in others,…
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ADRD Prevalence in Various Insurance Populations: A Collaboration with The Alzheimer’s Association
Read more: ADRD Prevalence in Various Insurance Populations: A Collaboration with The Alzheimer’s AssociationAlzheimer’s disease and related dementias (ADRD) represent a significant and growing cost to the United States health care system. While the prevalence and cost of ADRD related to Medicare Fee-for-Service beneficiaries is documented in the Center for Medicare and Medicaid Services’ Chronic Conditions Warehouse, less is known about the prevalence and cost of ADRD among…
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Comparing Post-Acute Care Use and First Site of Care Among Medicare Advantage Enrollees and Medicare Fee-for-Service Beneficiaries
Read more: Comparing Post-Acute Care Use and First Site of Care Among Medicare Advantage Enrollees and Medicare Fee-for-Service BeneficiariesUsing data from the Health Care Cost Institute (HCCI) and Centers for Medicare & Medicaid Services (CMS), we examined trends in inpatient hospital admissions and post-acute care (PAC) utilization among Medicare Advantage (MA) and Fee-for-Service (FFS) beneficiaries. Specifically, we compared how frequently individuals in each group were discharged from the hospital, whether they had evidence…
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American Economic Journal: Applied Economics: Health Care Spending and Utilization in Public and Private Medicare
Tags: American Economic Journal: Applied Economics, Medicare, Medicare Advantage, Peer Reviewed Journals, Spending, UtilizationRead more: American Economic Journal: Applied Economics: Health Care Spending and Utilization in Public and Private MedicareAbstract: We compare health care spending in public and private Medicare using newly available claims data from Medicare Advantage (MA) insurers. MA insurer revenues are 30 percent higher than their health care spending. Adjusting for enrollee mix, health care spending per enrollee in MA is 9 to 30 percent lower than in Traditional Medicare (TM),…
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Health Affairs: Medicare Advantage And Commercial Prices For Mental Health Services
Tags: Commercially Insured, Health Affairs, Medicare Advantage, Mental Health and Substance Use, Peer Reviewed JournalsRead more: Health Affairs: Medicare Advantage And Commercial Prices For Mental Health ServicesAbstract: In 2014, insurers paid an average of 13–14 percent less for in-network mental health services in their commercial and Medicare Advantage plans than fee-for-service Medicare paid for identical services—despite paying up to 12 percent more than Medicare when the same services were provided by other physician specialties. However, patients went out of network more…
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International Journal of Radiation Oncology: Impact of Medicare Advantage Enrollment on Utilization of Intensity-Modulated Radiation Therapy and Cost of Care for Cancer Treatment
Read more: International Journal of Radiation Oncology: Impact of Medicare Advantage Enrollment on Utilization of Intensity-Modulated Radiation Therapy and Cost of Care for Cancer TreatmentAbstract: Intensity-modulated radiation therapy (IMRT) is an important driver of rising costs in oncology care, but the level of evidence supporting its routine use varies across disease sites, including breast, lung, and prostate. While Medicare Advantage (MA) plans have incentives to reduce health care spending, the effect of MA enrollment on utilization of high-cost medical…
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Journal of General Internal Medicine: First Opioid Prescription and Subsequent High-Risk Opiod Use, a National Survey of Privately Insured and Medicare Advantage Adults
Read more: Journal of General Internal Medicine: First Opioid Prescription and Subsequent High-Risk Opiod Use, a National Survey of Privately Insured and Medicare Advantage AdultsBACKGROUND: National guidelines make recommendations regarding the initial opioid prescriptions, but most of the supporting evidence is from the initial episode of care, not the first prescription. OBJECTIVE: To examine associations between features of the first opioid prescription and high-risk opioid use in the 18 months following the first prescription. DESIGN: Retrospective cohort study using data from a large commercial insurance…
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Medical Care Research and Review: Prices for Physicians’ Services in Medicare Advantage and Commercial Plans
Tags: Commercially Insured, Medicare Advantage, Out-of-Network, Peer Reviewed Journals, Physician Spending, PricesRead more: Medical Care Research and Review: Prices for Physicians’ Services in Medicare Advantage and Commercial PlansABSTRACT: The prices that insurers pay physicians ultimately affect beneficiaries’ health insurance premiums. Using 2014 claims data from three major insurers, we analyzed the prices insurers paid in their Medicare Advantage (MA) and commercial plans for 20 physician services, in and out of network, and compared those prices with estimated amounts that Medicare’s fee-for-service (FFS) program…
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INQUIRY The Journal of Health Care Organization, Provision, and Financing: How do the Hospital Prices Paid by Medicare Advantage Plans and Commercial Plans Compare with Medicare Fee-for-Service Prices?
Tags: Commercially Insured, Inpatient Spending, Medicare, Medicare Advantage, Peer Reviewed Journals
Read more: INQUIRY The Journal of Health Care Organization, Provision, and Financing: How do the Hospital Prices Paid by Medicare Advantage Plans and Commercial Plans Compare with Medicare Fee-for-Service Prices?ABSTRACT The prices that private insurers pay hospitals have received considerable attention in recent years, but most of that literature has focused on the commercially insured population. Although nearly one-third of Medicare beneficiaries are enrolled in a Medicare Advantage (MA) plan, little is known about the prices paid to hospitals by the private insurers that…
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Health Payer Intelligence: Medicare Advantage Evaluation Requires Transparent Claims Data
Read more: Health Payer Intelligence: Medicare Advantage Evaluation Requires Transparent Claims DataBy Thomas Beaton February 23, 2018 – The growth of the Medicare Advantage (MA) market requires the release of more claims data to evaluate the commercial and government impact of the program, according to a recent JAMA commentary from the Health Care Cost Institute, ProPublica, and the VA. “Despite the important and increasing role of…