The Longitudinal Impact Of A Multistate Commercial Accountable Care Program On Cost, Use, And Quality.

The prevalence of accountable care organizations (ACOs) has grown significantly across Medicare and commercial payers in the past decade, but there are limited insights regarding the effect of ACOs on costs in the commercial population. We used longitudinal administrative claims data over the course of nineteen calendar quarters from 2016 to 2021 to assess the ongoing incremental impact of Elevance Health's commercial ACO program on cost and use across fifteen US states. We also analyzed the program's impact on spending subcategories (inpatient, outpatient, professional, and pharmacy) and measured differences in quality performance.

Encouraging Medicare Advantage Enrollees to Switch to Higher Quality Plans: Assessing the Effectiveness of a "Nudge" Letter.

There are considerable quality differences across private Medicare Advantage insurance plans, so it is important that beneficiaries make informed choices. During open enrollment for the 2013 coverage year, the Centers for Medicare & Medicaid Services sent letters to beneficiaries enrolled in low-quality Medicare Advantage plans (i.e.

One-Year Outcomes of Diabetes Self-Management Training Among Medicare Beneficiaries Newly Diagnosed With Diabetes.

Background: Diabetes is highly prevalent among Medicare beneficiaries, resulting in costly health care utilization. Strategies to improve health outcomes, such as disease self-management, could help reduce the increasing burden of diabetes.

Objectives: Short-term benefits of diabetes self-management training (DSMT) are established; however, longer-term impacts among Medicare beneficiaries are unknown.

Concordance between Self-Reports and Medicare Claims among Participants in a National Study of Chronic Disease Self-Management Program.

Objectives: To evaluate the concordance between self-reported data and variables obtained from Medicare administrative data in terms of chronic conditions and health care utilization.

Design: Retrospective observational study.

Participants: We analyzed data from a sample of Medicare beneficiaries who were part of the National Study of Chronic Disease Self-Management Program (CDSMP) and were eligible for the Centers for Medicare and Medicaid Services (CMS) pilot evaluation of CDSMP (n = 119).

The Roles of Cost and Quality Information in Medicare Advantage Plan Enrollment Decisions: an Observational Study.

Background: To facilitate informed decision-making in the Medicare Advantage marketplace, the Centers for Medicare & Medicaid Services publishes plan information on the Medicare Plan Finder website, including costs, benefits, and star ratings reflecting quality. Little is known about how beneficiaries weigh costs versus quality in enrollment decisions.

Objective: We aimed to assess associations between publicly reported Medicare Advantage plan attributes (i.

Use of Medicare's Diabetes Self-Management Training Benefit.

Medicare began reimbursing for outpatient diabetes self-management training (DSMT) in 2000; however, little is known about program utilization. Individuals diagnosed with diabetes in 2010 were identified from a 20% random selection of the Medicare fee-for-service population (N = 110,064). Medicare administrative and claims files were used to determine DSMT utilization.

Validity of a Claims-Based Diagnosis of Obesity Among Medicare Beneficiaries.

Population-level data on obesity are difficult to obtain. Claims-based data sets are useful for studying public health at a population level but lack physical measurements. The objective of this study was to determine the validity of a claims-based measure of obesity compared to obesity diagnosed with clinical data as well as the validity among older adults who suffer from chronic disease.

Leveraging Administrative Data for Program Evaluations: A Method for Linking Data Sets Without Unique Identifiers.

In community-based wellness programs, Social Security Numbers (SSNs) are rarely collected to encourage participation and protect participant privacy. One measure of program effectiveness includes changes in health care utilization. For the 65 and over population, health care utilization is captured in Medicare administrative claims data.

Utilization and costs of medications associated with CKD mineral and bone disorder in dialysis patients enrolled in Medicare Part D.

Background: Information is limited regarding utilization patterns and costs for chronic kidney disease-mineral and bone disorder (CKD-MBD) medications in Medicare Part D-enrolled dialysis patients.

Study Design: Retrospective cohort study.

Setting & Participants: Annual cohorts of dialysis patients, 2007-2010.

Association between Medicare Advantage plan star ratings and enrollment.

Importance: The US Centers for Medicare & Medicaid Services publishes star ratings reflecting Medicare Advantage plan quality to inform enrollment decisions.

Objective: To assess the association between publicly reported Medicare Advantage plan quality ratings and enrollment.

Design, Setting, And Participants: Cross-sectional study of 2011 Medicare Advantage enrollments among 952,352 first-time enrollees and 322,699 enrollees switching plans.

Sources of drug coverage among Medicare beneficiaries with ESRD.

Despite extensive use of prescription medications in ESRD, relatively little is known about the participation of Medicare ESRD beneficiaries in the Part D program. Here, we quantitated the sources of drug coverage among ESRD beneficiaries and explored the Part D plan preferences of ESRD beneficiaries with regard to deductibles, coverage gaps, and monthly premiums. We obtained data on beneficiary sources of creditable coverage, characteristics of Part D plans, demographics, and residence from the Centers for Medicare and Medicaid Chronic Condition Data Warehouse and identified beneficiaries with ESRD from the US Renal Data System.

Medicare beneficiary knowledge of the Part D program and its relationship with voluntary enrollment.

Background: The 2003 Medicare Modernization Act established the Part D drug benefit in 2006. Because the benefit involves a voluntary enrollment process with numerous plan options, there has been concern about whether beneficiaries have adequate knowledge of the program, but research on this issue has been limited.

Objectives: To examine Medicare beneficiary knowledge of the Part D program and estimate how knowledge affected voluntary enrollment decisions at the program's outset.

Utilization and costs of cardiovascular disease medications in dialysis patients in Medicare Part D.

Background: Cardiovascular disease (CVD) is a major source of mortality and morbidity in dialysis patients. Population-level descriptions of CVD medication use are lacking in this population.

Study Design: Retrospective cohort study.

Cost-related nonadherence to prescribed medication therapy among Medicare Part D beneficiaries with end-stage renal disease.

Purpose: Medication nonadherence due to cost issues among community-dwelling patients with end-stage renal disease (ESRD) enrolled in Medicare prescription drug plans was evaluated.

Methods: Demographic and health status data were collected on 1329 patients with ESRD enrolled in Medicare Part D prescription drug plans who responded to a Centers for Medicare and Medicaid Services consumer survey in early 2007. The survey data were assessed for self-reported cost-related nonadherence (CRN), defined as delaying or not filling a prescription due to cost concerns.

Prescription medication cost-related non-adherence among Medicare CAHPS respondents: disparity by Hispanic ethnicity.

Purpose: We examined whether there was disparity in prescription medication cost-related non-adherence (CRN) by Hispanic ethnicity among Medicare enrollees.

Methods: Multivariate logistic regression, adjusting for race, other socio-demographic variables, health status, health care utilization, and patient rating of their personal physician, was used to examine association of Hispanic ethnicity with CRN using cross-sectional data from Medicare's Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey (data collected in Spring 2007).

Results: Hispanic respondents constituted 6.

Do panel surveys make people sick? US arthritis trends in the Health and Retirement Study.

Researchers have long viewed large, longitudinal studies as essential for understanding chronic illness and generally superior to cross-sectional studies. In this study, we show that (1) age-specific arthritis prevalence in the longitudinal Health and Retirement Study (HRS) from the United States has risen sharply since its inception in 1992, and (2) this rise is almost surely spurious. In periods for which the data sets are comparable, we find no such increase in the cross-sectional National Health Interview Survey (NHIS), the primary source for prevalence data of chronic conditions in the US.