Multi-Payer Advanced Primary Care Practice Demonstration on quality of care.

Objectives: We evaluated whether primary care practices in the Medicare Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration improved the quality of care and patient outcomes for beneficiaries.

Study Design: For our quantitative analyses, we employed a pre-post study design with a comparison group using enrollment data, Medicare fee-for-service claims data, and Medicaid managed care and fee-for-service claims data, covering the period 2 to 4 years before Medicare joined the state patient-centered medical home initiatives through December 2014. We used difference-in-differences (DID) regression analysis to compare quality and outcomes in the period before and after the demonstration began.

Adapting Healthcare Quality Measures to Transgender Individuals.

The healthcare system's rapid shift toward value-based payment poses unique quality measurement challenges and new foci for researchers and policy makers. Quality measures that use sex-specific criteria may inappropriately include or exclude transgender individuals. More large-scale studies must be conducted to incorporate transgender individuals into measures that use sex-specific criteria, and "measure stewards" should consider the existing clinical guidelines and recommendations regarding transgender individuals when developing measures.

Financial and quality impacts of the Medicare physician group practice demonstration.

Objective: To examine the impact of the Medicare Physician Group Practice (PGP) demonstration on expenditure, utilization, and quality outcomes.

Data Source: Secondary data analysis of 2001-2010 Medicare claims for 1,776,387 person years assigned to the ten participating provider organizations and 1,579,080 person years in the corresponding local comparison groups.

Study Design: We used a pre-post comparison group observational design consisting of four pre-demonstration years (1/01-12/04) and five demonstration years (4/05-3/10).

Pharmaceutical technology assessment: perspectives from payers.

Background: Advancements in biologics and personalized medicine and the implementation of national prescription drug policies have likely prompted payers to implement additional health technology assessment and cost-containment strategies. A payer's decision to provide coverage for a drug and its associated benefit design draws on information from many sources. However, there is an incomplete understanding of the process employed and the criteria applied in formulary assessments of pharmaceuticals by public and private health plans.

Evaluation of the Massachusetts Behavioral Health Program: Year 8.

The eight-year provider evaluation of the Massachusetts Behavioral Health Program showed positive assessments of care provision, continuing problems in integration of care, high assessments of the clinical review process, high evaluations for administration, and positive ratings compared with other managed care organizations. Changes in provider organizations continue. Substance abuse and mental health providers gave similar ratings, while inpatient providers were more critical than outpatient providers.