medicare part c

Summary

Summary: The Balanced Budget Act (BBA) of 1997 establishes a Medicare+Choice program under part C of Title XVIII, Section 4001, of the Social Security Act. Under this program, an eligible individual may elect to receive Medicare benefits through enrollment in a Medicare+Choice plan. Beneficiaries may choose to use private pay options, establish medical savings accounts, use managed care plans, or join provider-sponsored plans.

Top Publications

  1. pmc Implementation of risk adjustment for Medicare
    M J Ingber
    Office of Strategic Planning, Health Care Financing Administration, Baltimore, MD 21244 1850, USA
    Health Care Financ Rev 21:119-26. 2000
  2. ncbi Reforming Medicare: impacts on federal spending and choice of health plans
    Kenneth E Thorpe
    Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
    Health Aff (Millwood) . 2001
  3. ncbi Rethinking adherence
    John F Steiner
    Institute for Health Research, Kaiser Permanente Colorado, Denver, CO 80237, USA
    Ann Intern Med 157:580-5. 2012
  4. ncbi Association between Medicare Advantage plan star ratings and enrollment
    Rachel O Reid
    Centers for Medicare and Medicaid Services, Center for Medicare and Medicaid Innovation, Rapid Cycle Evaluation Group, Baltimore, MD 21244, USA
    JAMA 309:267-74. 2013
  5. pmc Combining health plan performance indicators into simpler composite measures
    Alan M Zaslavsky
    Health Care Financ Rev 23:101-15. 2002
  6. pmc The effect of benefits, premiums, and health risk on health plan choice in the Medicare program
    Adam Atherly
    Department of Health Policy and Management, Emory University, Atlanta, GA 30322, USA
    Health Serv Res 39:847-64. 2004
  7. pmc Beneficiary reported experience and voluntary disenrollment in Medicare managed care
    Terry R Lied
    Health Care Financ Rev 25:55-66. 2003
  8. doi Medicare showdown
    John K Iglehart
    N Engl J Med 359:556-8. 2008
  9. pmc Payment policy and competition in the Medicare+Choice program
    Steven D Pizer
    Boston University, Department of Veterans Affairs, Abt Associates Inc, USA
    Health Care Financ Rev 24:83-94. 2002
  10. pmc Principal inpatient diagnostic cost group model for Medicare risk adjustment
    G C Pope
    Health Economics Research, Inc, Waltham, MA 02452, USA
    Health Care Financ Rev 21:93-118. 2000

Detail Information

Publications147 found, 100 shown here

  1. pmc Implementation of risk adjustment for Medicare
    M J Ingber
    Office of Strategic Planning, Health Care Financing Administration, Baltimore, MD 21244 1850, USA
    Health Care Financ Rev 21:119-26. 2000
    ....
  2. ncbi Reforming Medicare: impacts on federal spending and choice of health plans
    Kenneth E Thorpe
    Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
    Health Aff (Millwood) . 2001
    ..Our results highlight the fact that Medicare should expect modest savings from reforming the program. However, other goals of reform, such as establishing more efficient payments to plans, would be achieved...
  3. ncbi Rethinking adherence
    John F Steiner
    Institute for Health Research, Kaiser Permanente Colorado, Denver, CO 80237, USA
    Ann Intern Med 157:580-5. 2012
    ..To achieve the adherence goals set by CMS, front-line clinicians, interdisciplinary teams, organizational leaders, and policymakers will need to coordinate efforts in ways that exemplify the underlying principles of health care reform...
  4. ncbi Association between Medicare Advantage plan star ratings and enrollment
    Rachel O Reid
    Centers for Medicare and Medicaid Services, Center for Medicare and Medicaid Innovation, Rapid Cycle Evaluation Group, Baltimore, MD 21244, USA
    JAMA 309:267-74. 2013
    ..The US Centers for Medicare & Medicaid Services publishes star ratings reflecting Medicare Advantage plan quality to inform enrollment decisions...
  5. pmc Combining health plan performance indicators into simpler composite measures
    Alan M Zaslavsky
    Health Care Financ Rev 23:101-15. 2002
    ..These summaries are substantively interpretable, internally consistent, and describe the majority of variation among units in the performance scores analyzed...
  6. pmc The effect of benefits, premiums, and health risk on health plan choice in the Medicare program
    Adam Atherly
    Department of Health Policy and Management, Emory University, Atlanta, GA 30322, USA
    Health Serv Res 39:847-64. 2004
    ..To estimate the effect of Medicare+Choice (M+C) plan premiums and benefits and individual beneficiary characteristics on the probability of enrollment in a Medicare+Choice plan...
  7. pmc Beneficiary reported experience and voluntary disenrollment in Medicare managed care
    Terry R Lied
    Health Care Financ Rev 25:55-66. 2003
    ..The results demonstrate that voluntary disenrollment rates are strongly related to direct measures of patient experiences with care and are an important complement to other measures of health plan performance...
  8. doi Medicare showdown
    John K Iglehart
    N Engl J Med 359:556-8. 2008
  9. pmc Payment policy and competition in the Medicare+Choice program
    Steven D Pizer
    Boston University, Department of Veterans Affairs, Abt Associates Inc, USA
    Health Care Financ Rev 24:83-94. 2002
    ....
  10. pmc Principal inpatient diagnostic cost group model for Medicare risk adjustment
    G C Pope
    Health Economics Research, Inc, Waltham, MA 02452, USA
    Health Care Financ Rev 21:93-118. 2000
    ..In this article, the authors describe the risk-adjustment model HCFA is implementing in the year 2000, known as the Principal Inpatient Diagnostic Cost Group (PIPDCG) model...
  11. ncbi The welfare impact of Medicare HMOs
    Robert Town
    University of Minnesota, USA
    Rand J Econ 34:719-36. 2003
    ..Consumer surplus increases in the number of plans in a county, and most of the increase in welfare is due to increased premium competition...
  12. pmc Functional health outcomes as a measure of health care quality for Medicare beneficiaries
    A S Bierman
    Center for Outcomes and Effectiveness Research, Agency for Healthcare Research and Quality, Rockville, MD 20852, USA
    Health Serv Res 36:90-109. 2001
    ..To interpret the HOS as a quality measure individual-and plan-level differences in functional status and illness burden, as well as methodologic issues in health status measurement, need to be recognized and addressed...
  13. pmc The effect of health plan characteristics on Medicare+ Choice enrollment
    Bryan E Dowd
    Division of Health Services Research, University of Minnesota, Minneapolis 55455, USA
    Health Serv Res 38:113-35. 2003
    ..To provide national estimates of the effect of out-of-pocket premiums and benefits on Medicare beneficiaries' choice among managed care health plans...
  14. pmc Medicare health maintenance organization benefits packages and plan performance measures
    Don Cox
    BearingPoint, Inc, 1676 International Drive, McClean, VA 22102, USA
    Health Care Financ Rev 24:133-44. 2002
    ..Furthermore, disenrollment rates were found to be more sensitive to the availability of alternative M+C plans, either in general, or for specific benefits than to variations in benefit offerings...
  15. ncbi Health insurance knowledge among Medicare beneficiaries
    Lauren A McCormack
    RTI International, Research Triangle Park, NC 27709, USA
    Health Serv Res 37:43-63. 2002
    ..To assess the effect of new consumer information materials about the Medicare program on beneficiary knowledge of their health care coverage under the Medicare system...
  16. ncbi Medicare minus choice: the impact of HMO withdrawals on rural Medicare beneficiaries
    Michelle Casey
    Rural Health Research Center, Division of Health Services Research and Policy, University of Minnesota, USA
    Health Aff (Millwood) 21:192-9. 2002
    ....
  17. ncbi An examination of factors in the withdrawal of managed care plans from the Medicare+Choice program
    Mitchell P V Glavin
    Schneider Institute for Health Policy, Brandeis University, Waltham, MA 02454, USA
    Inquiry 39:341-54. 2002
    ..The findings suggest HMO participation in Medicare+Choice will continue to fall unless major changes are made to the overall Medicare program and the method of paying HMOs...
  18. ncbi A tale of four cities: Medicare reform and competitive pricing
    B Dowd
    Division of Health Services Research and Policy, University of Minnesota, USA
    Health Aff (Millwood) 19:9-29. 2000
    ..In the absence of political support, a demonstration of competitive pricing may be infeasible, and Congress could be forced to take the risky step of implementing broad Medicare reforms with very little information about their effects...
  19. pmc Impact of Medicare managed care market withdrawal on beneficiaries
    Bridget C Booske
    University of Wisconsin Madison, 610 Walnut Street, Number 1167, Madison, WI 53726, USA
    Health Care Financ Rev 24:95-115. 2002
    ..Of particular concern were the impacts on those in vulnerable subgroups such as the disabled, less educated, and minorities...
  20. pmc What does voluntary disenrollment from Medicare+Choice plans mean to beneficiaries?
    Lauren D Harris-Kojetin
    RTI International, 1615 M St, NW, Suite 740, Washington, DC 20036, USA
    Health Care Financ Rev 24:117-32. 2002
    ..Medicare beneficiaries do not easily understand disenrollment. We also discuss challenges in presenting useful disenrollment information and policy implications for public reporting...
  21. pmc Medigap premiums and Medicare HMO enrollment
    Catherine G McLaughlin
    Department of Health Management and Policy, School of Public Health, The University of Michigan, Ann Arbor 48109 2029, USA
    Health Serv Res 37:1445-68. 2002
    ..Similarly, our results imply that reforms to the Medicare HMO market would influence the demand for Medigap policies...
  22. ncbi Medicare+Choice: an interim report card
    M Gold
    Mathematica Policy Research, Washington, DC, USA
    Health Aff (Millwood) 20:120-38. 2001
    ....
  23. ncbi Disenrollment from Medicare HMOs
    K T Call
    Division of Health Services Research and Policy, School of Public Health, University of Minnesota, Box 729 Mayo, 420 Delaware Street SE, Minneapolis, MN 55455, USA
    Am J Manag Care 7:37-51. 2001
    ....
  24. ncbi National quality monitoring of Medicare health plans: the relationship between enrollees' reports and the quality of clinical care
    E C Schneider
    Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA
    Med Care 39:1313-25. 2001
    ..The clinical quality of health plans varies. The associations between different measures of health plan quality are incompletely understood...
  25. ncbi More managed care for Medicare
    William Atkinson
    Healthplan 44:18-22. 2003
  26. ncbi Impact of an annual dollar limit or "cap" on prescription drug benefits for Medicare patients
    Chien Wen Tseng
    Department of Family Practice and Community Health, University of Hawaii, and Pacific Health Research Institute, Honolulu, USA
    JAMA 290:222-7. 2003
    ..Annual dollar limits, or "caps," on drug benefits are common in Medicare managed care (Medicare + Choice) and have been part of several proposals for a national Medicare drug benefit...
  27. ncbi Comparison of cancer diagnosis and treatment in Medicare fee-for-service and managed care plans
    Gerald F Riley
    Office of Research, Development, and Information, Centers for Medicare and Medicaid Services, Baltimore, Maryland 21244, USA
    Med Care 46:1108-15. 2008
    ..To compare the Medicare managed care (MC) and fee-for-service (FFS) sectors on stage at diagnosis and treatment patterns for prostate, female breast, and colorectal cancers, and to examine patterns across MC plans...
  28. pmc Law and the public's health. Medicare reform
    Sara Rosenbaum
    The Department of Health Policy, School of Public Health and Health Services, George Washington University, DC, USA
    Public Health Rep 118:162-4. 2003
  29. pmc Risk selection and benefits in the Medicare+Choice program
    Roger Feldman
    University of Minnesota, Division of Health Services Research and Policy, Mayo Mail Code 729, 420 Delaware Street, SE, Minneapolis, MN 55455 0392, USA
    Health Care Financ Rev 25:23-36. 2003
    ..If M+C plans competed on the basis of benefits and premiums, as they would if they could give untaxed premium rebates, benefits that attract high risks would be underprovided...
  30. ncbi The impact of the Balanced Budget Act of 1997 on Medicare in the USA: the fallout continues
    Patrick A Rivers
    Graduate School of Health Administration and Policy, College of Business, Arizona State University, Tempe, Arizona, USA
    Int J Health Care Qual Assur Inc Leadersh Health Serv 15:249-54. 2002
    ..This article provides an update and examines the impacts of the Balanced Budget Act on health providers and medical education. The authors also discuss the implications of these impacts for further policy adjustment...
  31. ncbi Medicare+Choice
    Chris Serb
    Hosp Health Netw 77:42-4, 1. 2003
    ..But enrollment has dropped and health plans, complaining of low reimbursement rates, have fled. What went wrong? Can it be fixed?..
  32. pmc Medicare+Choice individual and group enrollment: 2001 and 2002
    Geoffrey R Hileman
    Actuarial Research Corporation, 5513 Twin Knolls Road, Suite 213, Columbia, MD 21045, USA
    Health Care Financ Rev 24:145-53. 2002
  33. ncbi Can managed care and competition control Medicare costs?
    Marsha Gold
    Mathematica Policy Research, Washington, DC, USA
    Health Aff (Millwood) . 2003
    ....
  34. ncbi Trends in retiree health benefits
    Lauren A McCormack
    RTI International, Research Triangle Park, North Carolina, USA
    Health Aff (Millwood) 21:169-76. 2002
    ..Indemnity enrollment remains strong among retirees, and employers are cautious about Medicare+Choice because of continuing plan withdrawals. Numerous indicators point to a further and accelerating decline in retiree coverage...
  35. ncbi Advantage cuts possible. Wyden wants regional data to rule on Medicare plan
    Jennifer Lubell
    Mod Healthc 37:8-9. 2007
  36. ncbi A review of data on the health sector of the United States January 2002
    Ida Hellander
    Physicians for a National Health Program, Chicago, IL 60602, USA
    Int J Health Serv 32:579-99. 2002
    ..Also provided is an update on Congressional activity on health care legislation, the role of health care industry money in politics, and some developments in health care systems elsewhere in the world...
  37. ncbi Influenza vaccination, hospitalizations, and costs among members of a Medicare managed care plan
    J W Davis
    Hawaii Medical Service Association, Honolulu, HI 96814, USA
    Med Care 39:1273-80. 2001
    ..Associations were weaker for subjects age 80 and older. The results, consistent with recommendations for the use of influenza vaccine, suggest that people ages 65 to 79 should be heavily targeted for vaccination...
  38. pmc Composite health plan quality scales
    Todd Caldis
    Centers for Medicare and Medicaid Services CMS, Baltimore, MD 21244 1850, USA
    Health Care Financ Rev 28:95-107. 2007
    ..90). External validity of the composite quality scale was checked by regressing the composite scale on Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey results for 1999...
  39. pmc A randomized controlled open trial of population-based disease and case management in a Medicare Plus Choice health maintenance organization
    David C Martin
    Coventry Health Care, Inc, PA, USA
    Prev Chronic Dis 1:A05. 2004
    ....
  40. ncbi PACE and the Medicare+Choice risk-adjusted payment model
    H Temkin-Greener
    Community Coalition for Long-Term Care, Inc, 10 Gibbs St, Suite 410, Rochester, NY 14604, USA
    Inquiry 38:60-72. 2001
    ..The PIP-DCG payment model bases its risk adjustment on inpatient diagnoses and does not capture adequately the risk of caring for a population with functional impairments...
  41. pmc Disenrollment information and Medicare plan choice: is more information better?
    Mark D Spranca
    Abt Associates, Cambridge, MA 02420, USA
    Health Care Financ Rev 28:47-59. 2007
    ..It also reduced decision quality for less educated intermediaries. Designers and sponsors of consumer-oriented materials should recognize that more information is not always better...
  42. ncbi Towers Perrin 2002 Health Care Cost Survey: what consumers and employers are doing about the increases
    Richard Ostuw
    Towers Perrin, USA
    Manag Care Q 10:16-25. 2002
  43. ncbi The Medicare Prescription Drug, Improvement and Modernization Act and the impact on care of people with chronic illness: benefit design and implementation issues
    Claudia Schlosberg
    Blank Rome LLP, Washington, DC 20037, USA
    Care Manag J 5:113-21. 2004
    ....
  44. ncbi Predictors of voluntary disenrollment from Medicare managed care
    Judy H Ng
    National Committee for Quality Assurance, Washington, District of Columbia 20036, USA
    Med Care 45:513-20. 2007
    ..However, total selection bias depends not only on who enrolls, but also on who disenrolls. Few studies examine selectivity in disenrollment; it is unclear how those who leave plans differ from those who remain...
  45. ncbi Pursuing cost containment in a pluralistic payer environment: from the aftermath of Clinton's failure at health care reform to the Balanced Budget Act of 1997
    Rick Mayes
    Department of Political Science, University of Richmond and Petris Centre on Health Care Markets and Consumer Welfare, University of California, Berkeley, CA, USA
    Health Econ Policy Law 1:237-61. 2006
    ....
  46. ncbi Medicare+Choice: what lies ahead?
    R Jeffrey Layne
    Fulbright and Jaworski LLP, Washington, D C, USA
    Healthc Financ Manage 56:70-4. 2002
    ..Congressional leaders have proposed various legislative remedies to improve the program, including creation of an entirely new pricing structure for the program based on a competitive bidding process...
  47. ncbi Having it all: national benefit equity and local payment parity in Medicare
    Bryan Dowd
    Division of Health Services Research and Policy, University of Minnesota School of Public Health, USA
    Health Aff (Millwood) 21:208-14. 2002
    ....
  48. ncbi Pay raise. Increased HMO funding excites many
    Jeff Tieman
    Mod Healthc 34:17. 2004
  49. ncbi Multiple prior years of health expenditures and Medicare health plan choice
    Matthew L Maciejewski
    Northwest HSR and D Center of Excellence, VA Puget Sound Health Care System, Department of Health Services, University of Washington, Seattle, WA, USA
    Int J Health Care Finance Econ 4:247-61. 2004
    ..The results indicate that beneficiaries use multiple years of expenditures in their choice of health plan and the effect of prior spending declined with time...
  50. ncbi Medicare+Choice: uncertain future for unstable program
    Frank Diamond
    Manag Care 11:28-35. 2002
  51. ncbi Medicare+Choice: doubling or disappearing?
    Robert A Berenson
    Academy for Health Services Research and Health Policy, USA
    Health Aff (Millwood) . 2001
    ....
  52. ncbi Medicare Advantage on hot seat. Congress presses officials on budgetary status quo
    Matthew DoBias
    Mod Healthc 37:8-9. 2007
  53. ncbi Managed care does not appear to have a spillover effect on the quality of diabetes care for Medicare patients
    Susan Edwards
    Health Care Financing and Organization, USA
    Find Brief 7:1-3. 2004
  54. ncbi Do the Medicare math, then make quick decision
    John Carroll
    Manag Care 13:18-20. 2004
  55. ncbi Further application of the care transitions intervention: results of a randomized controlled trial conducted in a fee-for-service setting
    Carla Parry
    University of Colorado Denver, Aurora, Colorado 80045, USA
    Home Health Care Serv Q 28:84-99. 2009
    ..Coaching chronically ill older patients and their caregivers to ensure that their needs are met during care transitions may reduce the rate of subsequent rehospitalization in a Medicare fee-for-service population...
  56. ncbi Sociodemographic differences in use of preventive services by women enrolled in Medicare+Choice plans
    Leo S Morales
    RAND Health, Santa Monica, CA 90407, USA
    Prev Med 39:738-45. 2004
    ..We examined the effect of sociodemographic factors on the receipt of mammography, colorectal cancer screening, and influenza vaccinations by women enrolled in two Medicare+Choice health plans...
  57. ncbi The Medicare world from both sides: a conversation with Tom Scully. Interview by Uwe E. Reinhardt
    Tom Scully
    United States Centers for Medicare and Medicaid Services, Baltimore, USA
    Health Aff (Millwood) 22:167-74. 2003
    ....
  58. ncbi Seniors with chronic health conditions and prescription drugs: benefits, wealth, and health
    Barry G Saver
    Department of Family Medicine, University of Washington, Seattle, WA 98195 4696, USA
    Value Health 7:133-43. 2004
    ....
  59. pmc The Medicare Health Outcomes Survey program: overview, context, and near-term prospects
    Nathaniel Jones
    Maryland Institute for Policy Analysis and Research MIPAR, University of Maryland, Baltimore County UMBC, 1000 Hilltop Circle, Baltimore, MD 21250, USA
    Health Qual Life Outcomes 2:33. 2004
    ..The new Medicare Prescription Drug, Improvement, and Modernization Act (2003) mandates the collection and use of data for outcomes measurement. Consequently, it is important to improve HOS to most effectively meet the mandate...
  60. ncbi Diabetes disease management in Medicare Advantage reduces hospitalizations and costs
    James L Rosenzweig
    Department of Medicine, Boston University, Boston, MA, USA
    Am J Manag Care 16:e157-62. 2010
    ..To evaluate the effectiveness of a telephonic diabetes disease management intervention in a Medicare Advantage population with comorbid diabetes and coronary artery disease (CAD)...
  61. pmc Adjusted community rate reforms to promote HMO participation in Medicare+Choice
    W E Encinosa
    University of Florida, USA
    Health Care Financ Rev 21:19-29. 1999
    ..The modifications include smoothing and bounding profit estimates and authorizing and encouraging expanded use of benefit stabilization funds...
  62. ncbi Innovations at Miami practice show promise for treating high-risk Medicare patients
    Craig Tanio
    ChenMed, Miami, Florida, USA
    Health Aff (Millwood) 32:1078-82. 2013
    ..Creating chronic disease centers focused on seniors with multiple chronic conditions is a promising delivery system innovation with major potential to improve the cost and quality of care...
  63. pmc Geographic variation in cardiovascular procedure use among Medicare fee-for-service vs Medicare Advantage beneficiaries
    Daniel D Matlock
    Division of General Internal Medicine, University of Colorado Denver School of Medicine, Aurora, CO 80045, USA
    JAMA 310:155-62. 2013
    ..Little is known about how different financial incentives between Medicare Advantage and Medicare fee-for-service (FFS) reimbursement structures influence use of cardiovascular procedures...
  64. ncbi Creating a competitive PSO: a case study
    J T Calvaruso
    Mount Carmel Health System, Columbus, OH, USA
    Healthc Financ Manage 53:39-41. 1999
    ..In the two years after instituting its provider-sponsored organization, Mount Carmel surpassed its original enrollment projections, decreased its patient management and utilization costs, and increased payments to its network members...
  65. ncbi Likelihood of hospital readmission after first discharge: Medicare Advantage vs. fee-for-service patients
    Bernard Friedman
    Agency for Healthcare Research and Quality AHRQ, 540 Gaither Road, Rockville, MD 20850, USA
    Inquiry 49:202-13. 2012
    ..Analytical methods to adjust for self-selection into particular plans or plan types should be considered when possible...
  66. ncbi Analysis of a large cohort of health maintenance organization patients with congestive heart failure
    Patricia Gladowski
    Quality Management Specialist, Highmark Blue Cross Blue Shield, Pittsburgh, PA 15222 3099, USA
    Am J Med Qual 18:73-81. 2003
    ..The use of a novel, cost-effective method for data collection resulted in the rapid acquisition of clinical data for analysis...
  67. pmc How successful is Medicare Advantage?
    Joseph P Newhouse
    Harvard Medical School Harvard School of Public Health Harvard University, John F Kennedy School of Government National Bureau of Economic Research
    Milbank Q 92:351-94. 2014
    b>Medicare Part C, or Medicare Advantage (MA), now almost 30 years old, has generally been viewed as a policy disappointment...
  68. pmc Risk adjustment for health plans disproportionately enrolling frail Medicare beneficiaries
    G F Riley
    Office of Strategic Planning, Health Care Financing Administration, Baltimore 21244, MD, USA
    Health Care Financ Rev 21:135-48. 2000
    ..Further refinements are needed if diagnosis-based models are used to pay plans that disproportionately enroll frail beneficiaries...
  69. ncbi Who really wants price competition in Medicare managed care?
    L M Nichols
    Urban Institute, Washington, D C, USA
    Health Aff (Millwood) 19:30-43. 2000
    ..A public report of this story may save future market-based Medicare reforms from a similar fate...
  70. pmc Depression care and treatment in a chronically ill Medicare population
    Hsiang Huang
    Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA 02139, USA
    Gen Hosp Psychiatry 35:382-6. 2013
    ..The purpose of this study is to examine depression care among chronically ill Medicare Advantage beneficiaries...
  71. ncbi Cost-lowering strategies used by medicare beneficiaries who exceed drug benefit caps and have a gap in drug coverage
    Chien Wen Tseng
    University of Hawaii Department of Family Practice and Community Health, Honolulu, and UCLA Department of Medicine, Los Angeles, Calif
    JAMA 292:952-60. 2004
    ....
  72. pmc Favorable selection, risk adjustment, and the Medicare Advantage program
    Michael A Morrisey
    Lister Hill Center for Health Policy, University of Alabama at Birmingham, Birmingham, AL 35294 0022, USA
    Health Serv Res 48:1039-56. 2013
    ..To examine the effects of changes in payment and risk adjustment on (1) the annual enrollment and switching behavior of Medicare Advantage (MA) beneficiaries, and (2) the relative costliness of MA enrollees and disenrollees...
  73. ncbi Medicare+Choice enrollees bring concerns to Capitol Hill
    Arnesa Howell
    Healthplan 43:20-1. 2002
  74. ncbi Medicare+Choice risk adjustment: don't leave money on the table
    J K Gorman
    Managed Care Compliance Solutions, Inc, Washington, D C, USA
    Healthc Financ Manage 55:45-8. 2001
    ..It is important to track members with chronic or terminal conditions that may qualify for higher payments and to appropriately code these conditions to optimize funds that may be owed to the organization...
  75. ncbi Economic burden and healthcare utilization associated with castration-resistant prostate cancer in a commercial and Medicare Advantage US patient population
    B Alemayehu
    Health Economics and Outcomes Research, AstraZeneca, 1800 Concord Pike, Wilmington, DE 19850, USA
    J Med Econ 13:351-61. 2010
    ..The objective of this study was to identify patients with CRPC from a medical claims database, and determine the prostate cancer-related economic burden and healthcare utilization of these patients...
  76. ncbi Expansion of dental benefits under the Medicare Advantage program
    Robert D Compton
    Delta Dental Plan of Massachusetts, 465 Medford St, Boston, MA 02129, USA
    J Dent Educ 69:1034-44. 2005
    ....
  77. ncbi Early evidence on the quality of care provided by special needs plans
    Matthew L Maciejewski
    Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC 27705, USA
    Med Care 49:891-6. 2011
    ..Medicare Advantage special needs plans (SNPs) have grown significantly over the past 7 years, but patient outcomes have only recently been publicly reported...
  78. pmc Retiree health insurance: recent trends and tomorrow's prospects
    Lauren A McCormack
    University of Wisconsin at Madison, USA
    Health Care Financ Rev 23:17-34. 2002
    ..The forces discouraging its growth--rising premium costs, a slower economy, judicial challenges, and an uncertain Medicare+Choice (M+C) program and policy agenda--far outweigh the forces likely to encourage expansion...
  79. ncbi Do Medicare Advantage enrollees tend to be admitted to hospitals with better or worse outcomes compared with fee-for-service enrollees?
    Bernard Friedman
    Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850, USA
    Int J Health Care Finance Econ 10:171-85. 2010
    ..With that proviso, the study justifies informing Medicare beneficiaries about the mortality and safety outcome measures for hospitals being used by a MA plan compared to hospitals used by FFS enrollees...
  80. ncbi Does Medicare managed care provide equal treatment for mental illness across races?
    Beth Virnig
    Division of Health Services Research and Policy, University of Minnesota School of Public Health, Minneapolis 55455, USA
    Arch Gen Psychiatry 61:201-5. 2004
    ..We examined the quality of mental health care received by elderly enrollees in Medicare + Choice plans...
  81. ncbi Medicare Advantage reforms: comparing House and Senate bills
    Brian Biles
    Department of Health Policy, Scool of Public Health and Health Services, George Washington University, USA
    Issue Brief (Commonw Fund) 74:1-12. 2009
    ..This issue brief compares the above and other provisions in the House and Senate bills, which have a common overall goal to improve the value that Medicare obtains for the dollars it spends..
  82. ncbi Regional associations between Medicare Advantage penetration and administrative claims-based measures of hospital outcomes
    Vivek T Kulkarni
    Yale University School of Medicine, New Haven, CT 06510, USA
    Med Care 50:406-9. 2012
    ..MA penetration varies greatly nationwide and seems to be associated with increased FFS population risk. Whether variation in MA penetration affects the performance on the Centers for Medicare and Medicaid Service measures is unknown...
  83. ncbi Medicare overpayments to private plans, 1985-2012: shifting seniors to private plans has already cost Medicare US$282.6 billion
    Ida Hellander
    The City University of New York, School of Public Health at Hunter College, New York, NY 10024, USA
    Int J Health Serv 43:305-19. 2013
    ..It is time to end Medicare's costly experiment with privatization. The U.S. needs to adopt a single-payer national health insurance program with effective methods for controlling costs...
  84. pmc New risk-adjustment system was associated with reduced favorable selection in medicare advantage
    J Michael McWilliams
    Department of Health Care Policy at Harvard Medical School, Boston, Massachusetts, USA
    Health Aff (Millwood) 31:2630-40. 2012
    ..Similar risk-adjustment methods may help reduce incentives for plans competing in health insurance exchanges and accountable care organizations to select patients with favorable clinical risks...
  85. ncbi Guideline-recommended medications: variation across Medicare Advantage plans and associated mortality
    Alfredo J Selim
    VA New England Health Care System, 200 Springs Rd, Bldg 70, Bedford, MA 01730, USA
    J Manag Care Pharm 19:132-8. 2013
    ..To evaluate variation in the prescription of guideline-recommended medications across Medicare Advantage (MA) plans and to determine whether such variation is associated with increased mortality...
  86. ncbi Cost and management of males with closed fractures
    S K Brenneman
    OptumInsight, 12525 Technology Drive, Eden Prairie, MN 55344, USA
    Osteoporos Int 24:825-33. 2013
    ..The mean medical cost per fracture was high ($6,078-$30,900), and osteoporosis management post fracture was inadequate in the majority of men...
  87. ncbi Pharmacist-provided telephonic medication therapy management in an MAPD plan
    Melea A Ward
    Humana Inc, Competitive Health Analytics, 321 W Main St, WFP6W, Louisville, KY 40202, USA
    Am J Manag Care 17:e399-409. 2011
    ....
  88. pmc Cost trends among commercially insured and Medicare Advantage-insured patients with chronic obstructive pulmonary disease: 2006 through 2009
    Anand A Dalal
    US Health Outcomes, GlaxoSmithKline, Research Triangle Park, Durham, NC 27709, USA
    Int J Chron Obstruct Pulmon Dis 6:533-42. 2011
    ....
  89. pmc Receipt of high risk medications among elderly enrollees in Medicare Advantage plans
    Danya M Qato
    Department of Health Services, Policy and Practice, Alpert Medical School of Brown University, 121 S Main St, Box G S121, Providence, RI 02912, USA
    J Gen Intern Med 28:546-53. 2013
    ..Since 2005, the Centers for Medicare and Medicaid Services (CMS) has required all Medicare Advantage (MA) plans to report prescribing rates of high risk medications (HRM)...
  90. ncbi How health reform legislation will affect Medicare beneficiaries
    Stuart Guterman
    Commonwealth Fund, USA
    Issue Brief (Commonw Fund) 81:1-10. 2010
    ....
  91. ncbi Medicare Advantage under fire. House and Senate have overpayments in their sights
    Matthew DoBias
    Mod Healthc 37:8-9. 2007
  92. ncbi The value of coverage in the medicare advantage insurance market
    Abe Dunn
    Bureau of Economic Analysis, U S Department of Commerce, 1441 L Street NW, Washington, DC 20230, United States
    J Health Econ 29:839-55. 2010
    ..The results of the demand model show that OOPC have a significant effect on consumer surplus and that not instrumenting for OOPC results in a significant underestimate of the value of coverage...
  93. ncbi Boost for Medicare Advantage. Congress questions why plans getting payment raise
    Matthew DoBias
    Mod Healthc 37:8-9. 2007
  94. ncbi Health care provider evaluation of a substitutive model of hospital at home
    Jill A Marsteller
    Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland 21205, USA
    Med Care 47:979-85. 2009
    ..To evaluate Hospital at Home (HaH), a substitute for inpatient care, from the perspectives of participating providers...
  95. ncbi The Medicare disadvantage
    Ken Ortolon
    Tex Med 103:41-2. 2007
  96. ncbi Search costs and Medicare plan choice
    Ian M McCarthy
    FTI Consulting, Dallas, TX, USA
    Health Econ 19:1142-65. 2010
    ..Our results suggest that, conditional on being uninformed, older, higher income beneficiaries with lower self-reported health status are more likely to utilize easier access to information...
  97. ncbi The association of adherence to osteoporosis therapies with fracture, all-cause medical costs, and all-cause hospitalizations: a retrospective claims analysis of female health plan enrollees with osteoporosis
    Rachel Halpern
    Health Economics and Outcomes Research, i3 Innovus, 12125 Technology Dr, MN002 0258, Eden Prairie, MN 55344, USA
    J Manag Care Pharm 17:25-39. 2011
    ..Poor adherence to osteoporosis medications is associated with higher general burden of illness compared with optimal adherence...
  98. ncbi No advantage. Little quality progress at managed-care plans: report
    Jennifer Lubell
    Mod Healthc 37:8-9. 2007
  99. pmc How do the experiences of Medicare beneficiary subgroups differ between managed care and original Medicare?
    Marc N Elliott
    RAND Corporation, Santa Monica, CA, USA
    Health Serv Res 46:1039-58. 2011
    ..To examine whether disparities in health care experiences of Medicare beneficiaries differ between managed care (Medicare Advantage [MA]) and traditional fee-for-service (FFS) Medicare...
  100. ncbi Health of Medicare Advantage plan enrollees at 1 year after Hurricane Katrina
    Lynda C Burton
    Johns Hopkins University Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 21205, USA
    Am J Manag Care 15:13-22. 2009
    ....
  101. ncbi The potential impact of the World Trade Organization's general agreement on trade in services on health system reform and regulation in the United States
    Nicholas Skala
    Northwestern University School of Law, Chicago, IL 60611, USA
    Int J Health Serv 39:363-87. 2009
    ....

Research Grants24

  1. The Role of Private Plans in Medicare
    JOSEPH PAUL NEWHOUSE; Fiscal Year: 2013
    ..Program Project is to undertake a fundamental examination of the theoretical and empirical underpinnings of Medicare Part C, or Medicare Advantage (MA) from a framework grounded in economic theory...
  2. Coverage, Organization of Care, and Colorectal Screening
    Eric Schneider; Fiscal Year: 2004
    ..Results of this study can guide the enactment of health policies that will increase rates of colorectal cancer screening and thereby reduce the incidence of colorectal cancer and its associated morbidity and mortality. ..
  3. Reimbursement Policy and Cancer Chemotherapy
    Joseph Newhouse; Fiscal Year: 2009
    ..Understanding its impact on chemotherapy treatment patterns has important implications not only for Medicare spending but also for the welfare of beneficiaries with cancer. ..
  4. MD Group Characteristics and Quality of Care for CHD
    Bruce Landon; Fiscal Year: 2003
    ..abstract_text> ..
  5. Financial Incentives and Variations in the Care of Medicare Beneficiaries
    Bruce E Landon; Fiscal Year: 2010
    ..Because patients will be clustered within physicians and physicians clustered within markets, we will use hierarchical analytic methods. ..
  6. Scalable PArtnering Network for CER: Across Lifespan, Conditions, and Settings
    John F Steiner; Fiscal Year: 2010
    ..Findings will inform evidence-based health care and improve the national allocation of health care resources. ..
  7. Development of an Instrument to Measure Health Literacy
    Lauren McCormack; Fiscal Year: 2009
    ....
  8. Enhancing the Safety of Warfarin in the Nursing Home
    Jerry Gurwitz; Fiscal Year: 2008
    ..abstract_text> ..
  9. An Epidemiologic Study of Lymph Node Evaluation in Colorectal Cancer Patients
    Beth Virnig; Fiscal Year: 2007
    ..Most CRC patient in the U.S. do not have an adequate node evaluation. This research will identify factors that affect the adequacy of lymph node staging in CRC so that improvements can be made. [unreadable] [unreadable]..
  10. Mental Health Spending and Quality of Care
    Thomas G McGuire; Fiscal Year: 2010
    ..We expand methods of the science of variations and apply them to mental health care using data from the Medicaid program. ..
  11. Health Information Technology in the Nursing Home
    Jerry Gurwitz; Fiscal Year: 2006
    ..abstract_text> ..
  12. Spatial Impact Factors and Mammography Screening
    Lee Mobley; Fiscal Year: 2006
    ..This work will demonstrate the feasibility of conducting a broader study encompassing more than twice as many counties of the United States (with additions covered by the expanded SEER database). ..
  13. HMO Research Network Conference
    Jerry Gurwitz; Fiscal Year: 2006
    ..unreadable] [unreadable] [unreadable] [unreadable]..
  14. SELECTION BIAS BY MEDICARE BENEFICIARIES WITH DIABETES
    Matthew Maciejewski; Fiscal Year: 2002
    ..Analyses will be conducted on a cohort of beneficiaries with diabetes in thc fee-for-service sector in 1992-1993, so results are not generalizable to people with diabetes who enrolled in Medicare HMOs prior to 1994...
  15. REDUCING ADVERSE DRUG EVENTS IN THE NURSING HOME
    Jerry Gurwitz; Fiscal Year: 2002
    ..abstract_text> ..
  16. MH AND ADVERSE SELECTION IN MANAGED CARE
    Thomas McGuire; Fiscal Year: 2001
    ..Understanding how adverse selection works in managed care and what can be done about it should be a very high priority for research. ..
  17. Industry-Sponsored Research Contracts:An Empirical Study
    Michelle Mello; Fiscal Year: 2002
    ..The data will be analyzed descriptively and with chi-squared tests and regression analysis. ..
  18. Effects of Health Plan Report Cards on Quality of Care
    MARY BUNDORF; Fiscal Year: 2004
    ..This information is essential for both large purchasers, such as the Medicare program and employers, and policy makers to determine the appropriate role of these types of interventions in improving quality of care. ..
  19. The Health Insurance Dynamics of Older Americans
    MARY BUNDORF; Fiscal Year: 2004
    ..abstract_text> ..
  20. Medicare + Choice a nd Minority Elderly
    Robert Morgan; Fiscal Year: 2004
    ..abstract_text> ..
  21. Industry-Sponsored Research Contracts:..Phase II
    Michelle Mello; Fiscal Year: 2004
    ..abstract_text> ..
  22. Economics of Racial & Ethnic Disparities in MH Services
    Thomas McGuire; Fiscal Year: 2005
    ..Test for evidence that patient reaction to provider discrimination leads to lower compliance rates and worse outcomes for these minorities. ..
  23. NETWORK EFFECTS IN MENTAL HEALTH MANAGED CARE
    Thomas McGuire; Fiscal Year: 2002
    ..4) Test the behavior of the managed care plans against the predictions of the optimal network theory. ..