Medicare

The federal program that covers medical care for people age 65 or older, younger people with disabilities, and people with End-Stage Renal Disease. Medicare covers about 13% of the US population and makes up a fifth of national health expenditures.

Physician Consolidation and the Spread of Accountable Care Organizations

Research Brief
Nov. 4, 2019

Accountable Care Organizations (ACOs) are groups of physicians and hospitals that jointly contract to care for a patient population. ACO contracts incentivize coordination of care across providers. This can lead to greater consolidation of physician practices, which can in turn generate higher costs and lower quality. Given this, the study asks, as ACOs enter health care markets, do physician practices grow larger?

Social and Health-Related Factors Associated with Enrollment in Medicare Advantage Plans in Older Adults

Robert Burke, MD, University of Pennsylvania
Oct. 16, 2019

Amit Kumar, Maricruz Rivera‐Hernandez, Amol M. Karmarkar, Lin‐Na Chou, Yong‐Fang Kuo, Julie A. Baldwin, Orestis A. Panagiotou, Robert E. Burke, Kenneth J. Ottenbacher 
 

Abstract [from journal]

Objectives: We assessed the characteristics of older Mexican American enrollees in traditional fee-for-service (FFS) and Medicare Advantage (MA) plans and the factors associated with disenrollment from FFS and enrollment in MA plans.

Design: Longitudinal study linked with Medicare claims data.

Setting: The Hispanic Established Populations for the Epidemiologic Study of the Elderly.

Participants: Community-dwelling Mexican American older adults (N = 1455).

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Association of Bundled Payments for Joint Replacement Surgery and Patient Outcomes With Simultaneous Hospital Participation in Accountable Care Organizations

Amole Navathe19-head
Oct. 9, 2019

Joshua M. Liao, Ezekiel J. Emanuel, Atheendar S. Venkataramani, Qian Huang, Claire T. Dinh, Eric Z. Shan, Erkuan Wang, Jingsan Zhu, Deborah S. Cousins, Amol S. Navathe

Abstract [from journal]

Importance:  An increasing number of hospitals have participated in Medicare’s bundled payment and accountable care organization (ACO) programs. Although participation in bundled payments has been associated with savings for lower-extremity joint replacement (LEJR) surgery, simultaneous participation in ACOs may be associated with different outcomes given the prevalence of LEJR among patients receiving care at ACO participant organizations and potential overlap in care redesign strategies adopted under the 2 payment models.

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Health Care Safety-Net Programs After The Affordable Care Act

Issue Brief
Oct. 1, 2019

Prior to the Affordable Care Act (ACA), health care safety-net programs were the primary source of care for over 44 million uninsured people. While the ACA cut the number of uninsured substantially, about 30 million people remain uninsured, and many millions more are vulnerable to out-of-pocket costs beyond their resources. The need for the safety net remains, even as the distribution and types of need have shifted. This brief reviews the effects of the ACA on the funding and operation of safety-net institutions. It highlights the challenges and opportunities that health care reform presents to safety-net programs, and how they have adapted and evolved to continue to serve our most vulnerable residents.

Medicare Coverage, With a Catch

Oct. 1, 2019

There’s good news and bad news. The good news is Medicare drug plans are increasing coverage of newer, better drugs to prevent blood clots in people at risk. The bad news is that coverage comes with significant strings attached, including higher patient copayments that could prevent access to the newer, better drugs.

Overlap between Medicare's Voluntary Bundled Payment and Accountable Care Organization Programs

Aug. 21, 2019

Amol S. Navathe, Claire Dinh, Sarah E. Dykstra, Rachel M. Werner, Joshua M. Liao

Abstract [from journal]

Accountable care organizations (ACOs) and bundled payments represent prominent value-based payment models, but the magnitude of overlap between the two models has not yet been described. Using Medicare data, we defined overlap based on attribution to Medicare Shared Savings Program (MSSP) ACOs and hospitalization for Bundled Payments for Care Improvement (BPCI) episodes at BPCI participant hospitals. Between 2013 and 2016, overlap as a share of ACO patients increased from 2.7% to 10% across BPCI episodes, while overlap as a share of all bundled

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Characteristics of Physicians Participating in Medicare's Oncology Care Model Bundled Payment Program

Aug. 8, 2019

Ravi B. Parikh, Justin E. Bekelman, Qian Huang, Joseph R. Martinez, Ezekiel J. Emanuel, Amol S. Navathe

Abstract [from journal]

Purpose: The Oncology Care Model (OCM) is Medicare's first bundled payment program for patients with cancer. We examined baseline characteristics of OCM physician participants and markets with high OCM physician participation to inform generalizability and complement the ongoing practice-level evaluation of the OCM.

Methods: In this cross-sectional study, we identified characteristics of US medical oncologists practicing in 2016, using a national telephone-verified physician database. We linked these data with

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