The Experts below are selected from a list of 159399 Experts worldwide ranked by ideXlab platform
Douglas R Wholey - One of the best experts on this subject based on the ideXlab platform.
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enter at your own risk hmo participation and enrollment in the Medicare risk market
Economic Inquiry, 2000Co-Authors: Jean Marie Abraham, Ashish Arora, Martin Gaynor, Douglas R WholeyAbstract:We examine HMO participation and enrollment in the Medicare risk market for the years 1990 to 1995. We develop a profit-maximization model of HMO behavior, which explicitly considers potential linkages between an HMO's production decision in the commercial enrollee market and its participation and production decisions in the Medicare risk market. Our results suggest that the payment rate is a primary determinant of HMO participation, while the price of a supplemental Medicare insurance policy positively affects HMO Medicare enrollment. We also find empirical support for the existence of complementarities in the joint production of an HMO's commercial and Medicare products. Copyright 2000 by Oxford University Press.
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enter at your own risk hmo participation and enrollment in the Medicarerisk market
National Bureau of Economic Research, 1999Co-Authors: Jean Marie Abraham, Ashish Arora, Martin Gaynor, Douglas R WholeyAbstract:We examine HMO participation and enrollment in the Medicare risk market for the years 1990 to 1995. We develop a profit- maximization model of HMO behavior, which explicitly considers potential linkages between an HMO's production decision in the commercial enrollee market and its participation and production decisions in the Medicare risk market. Our results suggest that the payment rate is a primary determinant of HMO participation, while the price of a supplemental Medicare insurance policy positively affects HMO Medicare enrollment. We also find empirical support for the existence of complementarities in the joint production of an HMO's commercial and Medicare products.
Joseph P. Newhouse - One of the best experts on this subject based on the ideXlab platform.
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Racial and Ethnic Differences in Use of Mammography Between Medicare Advantage and Traditional Medicare
Journal of the National Cancer Institute, 2013Co-Authors: John Z. Ayanian, Bruce E. Landon, Alan M. Zaslavsky, Joseph P. NewhouseAbstract:Breast cancer is a leading cause of cancer mortality for women in the United States, ranking first for Hispanic women and second behind lung cancer for black, Asian/Pacific Islander, and white women (1). To facilitate the diagnosis of breast cancer at earlier stages and reduce mortality, mammography is recommended by national guidelines in the United States for women aged 50 through 74 years, based on evidence from randomized clinical trials (2,3). At age 65 years, almost all US women become insured through the Medicare program, which began covering screening mammography biennially in 1991 and annually in 1998 (4). Since the Medicare Modernization Act in 2003, the proportion of Medicare beneficiaries enrolled in private health plans through the Medicare Advantage program has doubled from 13% in 2004 to 27% in 2012 (5), with the remainder enrolled in traditional fee-for-service Medicare. Among beneficiaries in Medicare Advantage in 2012, 65% were enrolled in health maintenance organizations (HMOs), and 28% were enrolled in preferred provider organizations (PPOs) (5). HMOs and PPOs receive capitated payments from Medicare and provide medical services through contracts with physicians and hospitals. Whereas HMOs have been widely available in Medicare since the mid-1990s, PPOs were rare before 2006 and have fewer restrictions on beneficiaries seeking care from physicians or hospitals outside PPO provider networks. Relative to traditional Medicare, Medicare HMOs and PPOs had lower patient cost-sharing for preventive services before 2010 (6), and they may have more organized systems to promote appropriate preventive services. Medicare HMOs and PPOs are required by the Centers for Medicare and Medicaid Services (CMS) to publicly report their use of mammography each year for women aged 65 to 69 years, whereas such reporting is not required in traditional Medicare. Recently, we found that overall mammography rates were statistically significantly higher in Medicare HMOs than in traditional Medicare by 17.9% in 2003 and by 13.5% in 2009 (7). Given their higher rates of mammography, Medicare HMOs may be more effective than traditional Medicare in eliminating racial and ethnic disparities in this service. Between 1997 and 2003, disparities in use of mammography between black and white women enrolled in Medicare HMOs narrowed, but rates for black women remained statistically significantly lower (8). Comparable data were not available for Hispanic or Asian/Pacific Islander women because of incomplete identification of these groups in Medicare enrollment data (9,10). Similarly, little is known about racial and ethnic disparities in Medicare PPOs, which have largely developed since 2006. Therefore, the objective of our study was to compare racial and ethnic differences in use of mammography in Medicare HMOs and PPOs relative to traditional Medicare. In addition to black and white women, we included Hispanic and Asian/Pacific Islander women using a new algorithm that identifies these latter two groups much more accurately (11).
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Quality of Ambulatory Care in Medicare Advantage HMOs and Traditional Medicare
Health affairs (Project Hope), 2013Co-Authors: John Z. Ayanian, Bruce E. Landon, Robert C. Saunders, L. Greg Pawlson, Joseph P. NewhouseAbstract:To compare quality of care nationally between Medicare Advantage health maintenance organizations (HMOs) and traditional Medicare and determine how various types of Medicare HMOs differed in quality from traditional Medicare, we assessed performance measures of the quality of ambulatory care from the among beneficiaries matched by demographic characteristics within local areas during 2003-2009. HMO enrollees were consistently more likely than traditional Medicare beneficiaries to receive appropriate breast cancer screening, diabetes care, and cholesterol testing for cardiovascular disease. Personal physicians were rated less highly in HMOs than traditional Medicare in 2003, but more highly in 2009. Not-for-profit, larger, and older HMOs performed consistently more favorably on clinical measures and ratings of care than for-profit, smaller, and newer HMOs. The effects on ambulatory quality of care of more integrated delivery systems in Medicare HMOs may outweigh the potential incentives to restrict care under capitated payments.
Marsha Gold - One of the best experts on this subject based on the ideXlab platform.
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Medicare Advantage — Lessons for Medicare's Future
The New England journal of medicine, 2012Co-Authors: Marsha GoldAbstract:One proposed solution to the problem of high and rising Medicare costs is to expand the use of private plans and market competition. What lessons for current Medicare policy can be gleaned from the history of Medicare Advantage plans?
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Medicare Advantage Lessons for Medicares Future
Mathematica Policy Research Reports, 2012Co-Authors: Marsha GoldAbstract:This article examines the lessons and limits of Medicare Advantage, private health plans, and market competition as proposed solutions to traditional Medicare's rising costs and growing eligibility rolls. Gold reviews Medicare's 30-year experience with voluntary private-plan enrollment—initially through HMOs and currently through Medicare Advantage plans—as an alternative to traditional Medicare.
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Medicares Private Plans A Report Card on Medicare Advantage MA
Mathematica Policy Research Reports, 2008Co-Authors: Marsha GoldAbstract:With higher payments and expanded private-plan authority, Medicare Advantage (MA) has caused the market to grow. One in three Medicare beneficiaries with Part D now gets this coverage through MA. Analysis of the sources of and reasons for enrollment growth suggest a troubling report card. Clearly, the Medicare Modernization Act (MMA) has expanded choice and the private-sector role. But it also has added to Medicare's complexity and costs and has created potential inequities, without apparent improvements in quality. However the debate ends, a stronger system of performance monitoring and accountability is needed to meet Medicare's essential fiduciary requirements and oversight responsibilities.
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Monitoring MedicareChoice What Have We Learned Findings and Operational Lessons for Medicare Advantage
Mathematica Policy Research Reports, 2004Co-Authors: Marsha Gold, Lori Achman, Jessica Mittler, Beth StevensAbstract:The role of private health plans in Medicare expanded substantially in 2004 under the Medicare Modernization Act, which builds on plan experience under Medicare+Choice, created in 1997 to offer more managed care choices for beneficiaries and recently renamed Medicare Advantage. Although sponsors originally hoped Medicare+Choice would lead to a greater role for private plans in Medicare, this report notes that the program is widely viewed as a failure, with plans leaving and beneficiaries having fewer, less attractive choices when the program ended in 2003 than they did when it began. As private plans continue to be a focal point for changing Medicare in the future, the researchers note that policymakers need a better understanding of the dynamics of the system to facilitate a successful transition in this latest effort.
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Medicare Advantage 2004 Payment Increases Resulting from the Medicare Modernization Act
Mathematica Policy Research Reports, 2004Co-Authors: Lori Achman, Marsha GoldAbstract:In recent years, Medicare+Choice enrollment declined as private health plans withdrew from the program, and monthly premiums and cost sharing rose in the remaining plans. In anticipation of an expanded role for private plans in 2006, the Medicare Modernization Act attempted to stabilize the program by authorizing additional payment increases for Medicare Advantage (formerly Medicare+Choice) plans in 2004, above what they were already slated to receive. This new paper profiles how Medicare payments to plans will change across the country, as well as the policy changes underlying the shift.
Stuart Guterman - One of the best experts on this subject based on the ideXlab platform.
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Does Medicare Advantage Cost Less Than Traditional Medicare
Issue brief (Commonwealth Fund), 2016Co-Authors: Brian Biles, Giselle Casillas, Stuart GutermanAbstract:The costs of providing benefits to enrollees in private Medicare Advantage (MA) plans are slightly less, on average, than what traditional Medicare spends per beneficiary in the same county. However, MA plans that are able to keep their costs comparatively low are concentrated in a fairly small number of U.S. counties. In the 25 counties where the cost differences between MA plans and traditional Medicare are largest, MA plans spent a total of $5.2 billion less than what traditional Medicare would have been expected to spend on the same beneficiaries, with health maintenance organizations (HMOs) accounting for all of that difference. In the rest of the country, MA plans spent $4.8 billion above the expected costs under traditional Medicare. Broad determinations about the relative efficiency of MA plans and traditional Medicare can therefore be misleading, as they fail to take into account local conditions and individual plans' performance.
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Variations In County-Level Costs Between Traditional Medicare And Medicare Advantage Have Implications For Premium Support
Health affairs (Project Hope), 2015Co-Authors: Brian Biles, Giselle Casillas, Stuart GutermanAbstract:Concern about the future growth of Medicare spending has led some in Congress and elsewhere to promote converting Medicare to a “premium support” system. Under premium support, Medicare would provide a “defined contribution” to each Medicare beneficiary to purchase either a Medicare Advantage (MA)–type private health plan or the traditional Medicare public plan. To better understand the implications of such a shift, we compared the average costs per beneficiary of providing Medicare benefits at the county level for traditional Medicare and four types of MA plans. We found that the relative costs of Medicare Advantage and traditional Medicare varied greatly by MA plan type and by geographic location. The costs of health maintenance organization–type plans averaged 7 percent less than those of traditional Medicare, but the costs of the more loosely structured preferred provider organization and private fee-for-service plans averaged 12–18 percent more than those of traditional Medicare. In some counties MA ...
Jacob A. Robbins - One of the best experts on this subject based on the ideXlab platform.
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The spillover effects of Medicare managed care: Medicare Advantage and hospital utilization
Journal of health economics, 2013Co-Authors: Katherine Baicker, Michael E. Chernew, Jacob A. RobbinsAbstract:More than a quarter of Medicare beneficiaries are enrolled in Medicare Advantage, which was created in large part to improve the efficiency of health care delivery by promoting competition among private managed care plans. This paper explores the spillover effects of the Medicare Advantage program on the traditional Medicare program and other patients, taking advantage of changes in Medicare Advantage payment policy to isolate exogenous increases in Medicare Advantage enrollment and trace out the effects of greater managed care penetration on hospital utilization and spending throughout the health care system. We find that when more seniors enroll in Medicare managed care, hospital costs decline for all seniors and for commercially insured younger populations. Greater managed care penetration is not associated with fewer hospitalizations, but is associated with lower costs and shorter stays per hospitalization. These spillovers are substantial – offsetting more than 10% of increased payments to Medicare Advantage plans.
