Using 1993 and 1994 data, the authors examine whether beneficiaries who enroll in a Medicare health maintenance organization (HMO), including those enrolling for only a short period of time, have lower expenditures than continuous fee-for-service (FFS) beneficiaries the year prior to enrollment. We also test whether biased selection varies by the level of HMO market penetration and the rate of market-share growth. We find favorable selection associated with enrollment into Medicare HMOs, which declines as market share increases but does not disappear. Among short-term enrollees, we find unfavorable selection, however, selection bias was not sensitive to market characteristics.
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Health Aff Sch
January 2025
Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, United States.
Enrollment in Medicare Advantage (MA) plans rose to over 50% of eligible Medicare patients in 2023. Payments to MA plans incorporate risk scores that are largely based on patient diagnoses from the prior year, which incentivizes MA plans to code diagnoses more intensively. We estimated coding inflation rates for individual MA contracts using a method that allows for differential selection into contracts based on patient health.
View Article and Find Full Text PDFJAMA Netw Open
November 2024
Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
Importance: Compared with traditional Medicare (TM), Medicare Advantage (MA) insurers have greater financial incentives to reduce the delivery of low-value services (LVS); however, there is limited evidence at a national level on the prevalence of LVS utilization among MA vs TM beneficiaries and whether LVS utilization rates vary among the largest MA insurers.
Objective: To determine whether there are differences in the rates of LVS delivered to Medicare beneficiaries enrolled in MA vs TM, overall and by the 7 largest MA insurers.
Design, Setting, And Participants: This cross-sectional study included Medicare beneficiaries aged 65 years and older residing in the US in 2018 with complete demographic information.
Cureus
September 2024
Radiation Oncology, University of California San Francisco Medical Center, San Francisco, USA.
Ann Plast Surg
January 2025
From the Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor MI.
Background: Policy impacting traditional Medicare beneficiaries may have unintended effects for privately insured patients. After the repeal of a longstanding $1500 outpatient therapy cap in 2018, we aimed to evaluate if this policy change was associated with differences in use of cost of postoperative therapy after common hand surgeries, including carpal tunnel release, trigger finger release, ganglion cyst excision, De Quervain tenosynovitis release, carpometacarpal arthroplasty, and distal radius fracture open reduction/internal fixation or percutaneous pinning.
Methods: The Medicare Supplement and Coordination of Benefits files from Marketscan were used.
Health Serv Res
August 2024
Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
Objective: To examine whether certain Medicare Advantage (MA) plan characteristics are associated with driving beneficiaries to providers that generate fewer avoidable hospital stays.
Data Sources: This paper primarily used 2018-2019 MA encounter data and traditional Medicare (TM) claims data for a nationally representative 20% sample of Medicare beneficiaries.
Study Design: For each plan design aspect-plan type, carrier, star rating, and network breadth-we estimated two adjusted Poisson regressions of avoidable hospital stays: one without clinician fixed effects and the other with.
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