scholarly journals Quality Advantage? Provider Quality and Networks in Medicare Advantage

2020 ◽  
Vol 6 (2) ◽  
pp. 138 ◽  
Author(s):  
Simon F. Haeder
Keyword(s):  
New York ◽  
Metropolitan Areas ◽  
Artery Bypass ◽  
Insurance Coverage ◽  
Medicare Advantage ◽  
Medicare Beneficiaries ◽  
Provider Quality ◽  
Medicare Program ◽  
Network Adequacy ◽  
Cardiac Surgeons

Medicare Advantage plans have grown significantly over the past decade and the potential for their future growth seems unabated. Astonishingly, however, we know little about how Medicare beneficiaries access services, particularly whether those services are of high quality. This study explores access to cardiac surgeons for coronary artery bypass grafting (CABG) and heart valve surgery in California and New York. It is one of the first studies to analyze Medicare Advantage networks and interactions between provider networks and provider quality. Results of the study show that for large metropolitan areas, access is rather similar for traditional Medicare and Medicare Advantage beneficiaries. Limitations, however, exist for the latter. Important concerns emerge for Medicare Advantage beneficiaries outside of metropolitan areas where healthcare market challenges appear to be exacerbated by carrier restrictions. Results indicate no evidence that carriers selectively contract to improve quality. There is, however, significant diversity with regard to network breadth; and, this breadth does not stay static across distances. These results hold important implications for the future of the Medicare program, network adequacy regulations, and how consumers make choices about their insurance coverage. 

New York’s Medicare Marketplace: Examining New York’s Medicare Advantage Plan Landscape in Light of Payment Reform

2013 ◽  
Vol 14 (3) ◽  
pp. 187-196 ◽  
Keyword(s):  
New York ◽  
Performance Metrics ◽  
New York State ◽  
Cost Savings ◽  
Medicare Advantage ◽  
Medicare Beneficiaries ◽  
Payment Reform ◽  
Cost Structures ◽  
Sound Policy ◽  
And Performance

The Patient Protection and Affordable Care Act (ACA) provided for cost savings in the Medicare program, in part to underwrite coverage expansion to Medicare beneficiaries, to finance new coverage for those not eligible for Medicare, and to strengthen Medicare’s financial outlook. One cost-saving measure, a reformulation and reduction in payments to private health insurance plans that provide Medicare benefits through the Medicare Advantage (MA) program, had a sound policy basis but was criticized, particularly by opponents of the ACA, as a measure that would lead to increased costs, reductions in benefits, and diminished plan choices to Medicare beneficiaries enrolled in MA plans. Despite dire predictions to this effect, a review of a sample of MA plan offerings in New York State in 2012 shows that Medicare beneficiaries enrolled in such plans did not experience significant benefit reductions or increased costs. While the number of plan offerings decreased, the reduction was mostly caused by the elimination of duplicative plan choices in 2011. Although the MA plan executives we interviewed indicated that further reductions in plan reimbursement in future years—tempered by potential bonus payments for meeting quality and performance metrics—could impact plan costs and benefits, they believed plans will employ a number of strategies to remain in the market and maintain beneficiary benefits and cost structures. However, government regulators and consumer advocates will need to examine MA plan offerings in the coming years to determine the effect of plan reaction to the ACA payments on beneficiaries’ costs for coverage and access to care.

scholarly journals The Consequences of Health Care Privatization: Evidence from Medicare Advantage Exits

2018 ◽  
Vol 10 (1) ◽  
pp. 153-186 ◽  
Author(s):  
Mark Duggan ◽  
Jonathan Gruber ◽  
Boris Vabson
Keyword(s):  
New York ◽  
Hospital Inpatient ◽  
Fee For Service ◽  
Medicare Advantage ◽  
Exogenous Shocks ◽  
Inpatient Utilization ◽  
Medicare Program ◽  
Considerable Controversy ◽  
Health Care Privatization ◽  
Managed Care Organizations

There is considerable controversy over the use of private insurers to deliver public health insurance benefits. We investigate the consequences of patients enrolling in Medicare Advantage (MA), privately managed care organizations that compete with the traditional fee-for-service Medicare program. We use exogenous shocks to MA enrollment arising from plan exits from New York counties in the early 2000s and utilize unique data that links hospital inpatient utilization to Medicare enrollment records. We find that individuals who were forced out of MA plans due to plan exit saw very large increases in hospital utilization. These increases appear to arise through plans both limiting access to nearby hospitals and reducing elective admissions, yet they are not associated with any measurable reduction in hospital quality or patient mortality. (JEL G22, I11, I12, I13, I18)

scholarly journals Quality Regulation? Access to High-Quality Specialists for Medicare Advantage Beneficiaries in California

2019 ◽  
Vol 6 ◽  
pp. 233339281882447 ◽  
Author(s):  
Simon F. Haeder
Keyword(s):  
Rural Areas ◽  
Metropolitan Areas ◽  
Quality Measures ◽  
Medicare Advantage ◽  
Provider Choice ◽  
The Past ◽  
Quality Regulation ◽  
Provider Quality ◽  
Provider Networks ◽  
Individual Provider

Medicare Advantage enrollment has seen tremendous growth over the past decade. However, we know comparatively little about the experience of beneficiaries in the program. Our knowledge of Medicare Advantage provider networks is particularly limited. This article is one of the first major assessments of the issue. It seeks to answer 3 important questions. First, are Medicare Advantage plan networks made up of higher quality providers? Second, how significant are the network restrictions imposed by Medicare Advantage plans with regard to access to higher quality providers? And finally, how much provider choice are Medicare Advantage beneficiaries left with? To assess these questions, I utilize geospatial data and individual provider quality measures for cardiologists, endocrinologists, and obstetricians and gynecologists from California. I find that Medicare Advantage beneficiaries generally do well in large metropolitan areas compared to traditional Medicare. However, there are concerns for those in micropolitan and rural areas, and even those in standard metropolitan areas, at times. Crucially, the connection between provider quality and networks can only be fully understood when connected to assessments of provider access. These findings also raise questions about how we think about provider networks and the adequacy of current approaches to network regulation.

Does Medicare Advantage Reduce Racial Disparity in 30-Day Rehospitalization for Medicare Beneficiaries?

2016 ◽  
Vol 75 (2) ◽  
pp. 175-200 ◽  
Author(s):  
Yue Li ◽  
Xi Cen ◽  
Xueya Cai ◽  
Dongliang Wang ◽  
Caroline Pinto Thirukumaran ◽  
...  
Keyword(s):  
New York ◽  
Racial Disparity ◽  
Readmission Rate ◽  
New York State ◽  
Ethnic Disparities ◽  
Medicare Advantage ◽  
Medicare Beneficiaries ◽  
Hospital Administrative ◽  
Hospital Administrative Data ◽  
York State Hospital

This study determined potential racial and ethnic disparities in risk for all-cause 30-day readmission among traditional Medicare (TM) and Medicare Advantage (MA) beneficiaries initially hospitalized for acute myocardial infarction, congestive heart failure, or pneumonia. Our analyses of New York State hospital administrative data between 2009 and 2012 found that overall 30-day readmission rate declined from 22.0% in 2009 to 20.7% in 2012 for TM beneficiaries, and from 20.2% in 2009 to 17.9% in 2012 for MA beneficiaries. However, persistent racial disparities were found in propensity-score–based analyses among TM beneficiaries (e.g., in 2012, adjusted odds ratio [OR] = 1.11, 95% confidence interval [CI] = 1.01-1.23, p = .029), though not among MA beneficiaries (in 2012, adjusted OR = 1.05, 95% CI = 0.92-1.19, p = .476). We did not find evidence of persistent ethnic disparity for TM (in 2012, adjusted OR = 1.08, 95% CI = 0.93-1.25, p = .303) or MA (in 2012, adjusted OR = 0.99, 95% CI = 0.88-1.11, p = .837) beneficiaries. We conclude that enrollment in MA seemed to be associated with significantly reduced readmission rate and potentially reduced racial disparity.

scholarly journals Commentary: Don’t Further Privatize Medicare

2019 ◽  
Vol 56 ◽  
pp. 004695801986761
Author(s):  
David A. Lipschutz
Keyword(s):  
Health Insurance ◽  
Lower Cost ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Medicare Advantage ◽  
Medicare Program

The Medicare program is quietly becoming privatized through increasing enrollment in Medicare Advantage (MA) plans, even though MA has not lived up to its promise of delivering better care at lower cost. Policymakers must reverse this trend and ensure parity between traditional Medicare and MA rather than encourage it through legislation that only benefits MA. Furthermore, as discussions of expanding health insurance coverage through Medicare intensify, policymakers should explore what version of Medicare they wish to expand.

scholarly journals The Transformation of Medicare, 2015 to 2030

2015 ◽  
Vol 18 (2) ◽  
pp. 119-136
Author(s):  
Henry J. Aaron ◽  
Robert Reischauer
Keyword(s):  
Private Insurance ◽  
Public Law ◽  
Medicare Advantage ◽  
Medicare Beneficiaries ◽  
Working Population ◽  
Payment Reform ◽  
Medicare Program ◽  
Lyndon Johnson ◽  
Regulatory Powers

Abstract Medicare today is a better program on almost every dimension than it was just after July 30, 1965 when Lyndon Johnson signed public law 89–97. Nonetheless, short-comings, limitations, and inadequacies remain. What should be done to make Medicare a better program? What should Medicare look like in 2030? In this paper we try to answer these questions. Three perspectives are relevant: that of beneficiaries, current and future; that of policymakers and administrators, the program’s stewards; and that of society at large. We posit certain objectives and goals that we believe – and that we think a broad swath of Americans would agree – should be pursued to improve the Medicare program. Those goals include (a) affordability for Medicare beneficiaries, (b) affordability for the working population that is paying and should continue to pay for much of the current cost of the program, (c) reduction in what we regard as needless complexity, and (d) stability and continuity in several different senses. We restrict ourselves to changes that we judge to be affordable and feasible – politically, technically, and administratively – if not today, then over the next decade or two. We believe that changes in Medicare will remain incremental, as they have been for the last 50 years. We shall assume that the ACA takes root and that the exchanges, whether managed by states or by the federal government on behalf of the states, continue to operate. We shall assume that federal and state officials eventually surmount the administrative challenges they still confront. In particular, we assume that the exchanges come to serve a growing share of the American population and that they increasingly exercise the rather considerable regulatory powers over insurance offerings that the ACA grants to them. We divide Medicare reforms into four categories: payment reform, benefit reform, quality reform and management, and the role of private insurance plans (Medicare Advantage [MA]).

scholarly journals The High Coverage of Dental, Vision, and Hearing Benefits Among Medicare Advantage Enrollees

2019 ◽  
Vol 56 ◽  
pp. 004695801986155
Author(s):  
Amber Willink
Keyword(s):  
Low Income ◽  
Medicare Advantage ◽  
Medicare Beneficiaries ◽  
High Coverage ◽  
Policy Makers ◽  
Medicare Program ◽  
Access To Health ◽  
Medicaid Beneficiaries ◽  
Supplemental Services ◽  
Do So

While the traditional Medicare program does not cover dental, vision, and hearing services, Medicare Advantage (MA) plans have been given the flexibility to do so. However, it is not known how many MA enrollees are in plans that cover these services. The 2016 Medicare Current Beneficiary Survey linked to MA plan benefit data is used to examine enrollment levels in plans that cover dental, vision, and/or hearing services in MA. Medicaid beneficiaries are excluded from this analysis as coverage of supplemental benefits is largely determined by the state. The highest coverage of supplemental services is vision, followed by hearing and dental (71%, 56%, and 41%, respectively). Across all supplemental services, coverage for supplemental benefits is highest among low-income beneficiaries and those who have not completed high school. Hispanic Medicare beneficiaries had the highest enrollment in plans that offered a supplemental benefit, and white Medicare beneficiaries tended to have the lowest enrollment in these plans. Unlike in traditional Medicare, MA enrollees have access to health plans that offer supplemental benefits, including dental, vision, and/or hearing services. This analysis shows that enrollment in these plans is highest among low-income MA enrollees who may not have the means to purchase stand-alone insurance for these services in traditional Medicare. More analysis is warranted to examine the generosity of the coverage of these services in MA plans. However, for federal policy makers to consider offering supplemental coverage in traditional Medicare, the MA experience suggests this type of benefit would be valuable.

Why Choose Cardiothoracic Surgery as a Career?

2011 ◽  
Vol 14 (3) ◽  
pp. 142 ◽  
Author(s):  
Raja R. Gopaldas ◽  
Faisal G. Bakaeen ◽  
Danny Chu ◽  
Joseph S. Coselli ◽  
Denton A. Cooley
Keyword(s):  
Technological Progress ◽  
Artery Bypass ◽  
Cardiothoracic Surgery ◽  
Faculty Members ◽  
New Graduates ◽  
The Future ◽  
Cardiac Surgeon ◽  
The Right ◽  
Cardiac Surgeons ◽  
The Ideal

The future of cardiothoracic surgery faces a lofty challenge with the advancement of percutaneous technology and minimally invasive approaches. Coronary artery bypass grafting (CABG) surgery, once a lucrative operation and the driving force of our specialty, faces challenges with competitive stenting and poor reimbursements, contributing to a drop in applicants to our specialty that is further fueled by the negative information that members of other specialties impart to trainees. In the current era of explosive technological progress, the great diversity of our field should be viewed as a source of excitement, rather than confusion, for the upcoming generation. The ideal future cardiac surgeon must be a "surgeon-innovator," a reincarnation of the pioneering cardiac surgeons of the "golden age" of medicine. Equipped with the right skills, new graduates will land high-quality jobs that will help them to mature and excel. Mentorship is a key component at all stages of cardiothoracic training and career development. We review the main challenges facing our specialty�length of training, long hours, financial hardship, and uncertainty about the future, mentorship, and jobs�and we present individual perspectives from both residents and faculty members.

scholarly journals Babesiosis Occurrence among the U.S. Medicare Beneficiaries Ages 65 and Older, During 2006-2017: Overall, and by State and County of Residence

2020 ◽  
Author(s):  
Mikhail Menis ◽  
Barbee I Whitaker ◽  
Michael Wernecke ◽  
Yixin Jiao ◽  
Anne Eder ◽  
...  
Keyword(s):  
New York ◽  
Rhode Island ◽  
Parasitic Infection ◽  
Medicare Beneficiaries ◽  
Study Objective ◽  
Diagnosis Codes ◽  
Real World Evidence ◽  
At Risk Populations ◽  
Human Babesiosis ◽  
The U.S

Abstract Background Human babesiosis is a mild-to-severe parasitic infection that poses health concerns especially in older and other at-risk populations. The study objective was to assess babesiosis occurrence among the U.S. Medicare beneficiaries, ages 65 and older, during 2006-2017. Methods Our retrospective claims-based study utilized Medicare databases. Babesiosis cases were identified using recorded diagnosis codes. The study estimated rates (per 100,000 beneficiary-years) overall, by year, diagnosis month, demographics, state and county of residence. Results Nationwide, 19,469 beneficiaries had babesiosis recorded, a rate of 6 per 100,000 person-years, ranging from 4 in 2006 to 9 in 2017 (p<0.05). The highest babesiosis rates were in: Massachusetts (62), Rhode Island (61), Connecticut (51), New York (30), and New Jersey (19). The highest rates by county were in: Nantucket, MA (1,089); Dukes, MA (236); Barnstable, MA (213); and Dutchess, NY (205). Increasing rates, from 2006 through 2017 (p<0.05), were identified in multiple states, including states previously considered non-endemic. New Hampshire, Maine, Vermont, Pennsylvania, and Delaware saw rates increase by several times. Conclusion Our 12-year study shows substantially increasing babesiosis diagnosis trends, with highest rates in well-established endemic states. It also suggests expansion of babesiosis infections in other states and highlights the utility of real-world evidence.

Values of Voluntary Simplicity: Lifestyle and Motivation

1984 ◽  
Vol 55 (1) ◽  
pp. 231-240 ◽  
Author(s):  
Avraham Shama ◽  
Joseph Wisenblit
Keyword(s):  
United States ◽  
New York ◽  
New York City ◽  
York City ◽  
Metropolitan Areas ◽  
The United States ◽  
Voluntary Simplicity ◽  
Ecological Responsibility ◽  
Self Sufficiency ◽  
And Behavior

This paper describes the relation between values and behavior of a new life style, that of voluntary simplicity which is characterized by low consumption, self-sufficiency, and ecological responsibility. Also, specific hypotheses regarding the motivation for voluntary simplicity and adoption in two areas of the United States were tested. Analysis shows (a) values of voluntary simplicity and behaviors are consistent, (b) the motivation for voluntary simplicity includes personal preference and economic hardship, and (c) adoption of voluntary simplicity is different in the Denver and New York City metropolitan areas.

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