Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1056/NEJMc1114006 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Hospital Medicare Spending per Beneficiary: A Longitudinal Study.
J Healthc Manag
January 2025
Division of Health Care Delivery Research, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Jacksonville, Florida.
Goal: While studies have examined quality and health outcomes related to the Centers for Medicare & Medicaid Services' (CMS's) Hospital Value-Based Purchasing (HVBP) Program, a significant gap exists in the literature regarding the relationship between pay-for-performance initiatives and hospital financial performance in the program's Efficiency and Cost Reduction domain. This study examined the association between hospitals' cost inefficiency and participation in the HVBP Program by estimating the probability and magnitude of improvement or achievement in the program's Efficiency and Cost Reduction domain.
Methods: The 2014-2019 Efficiency and Cost Reduction domain data were obtained from CMS and merged with the American Hospital Association's Annual Survey Database.
Background: Prior research has explored the link between health information technology (HIT) and performance of accountable care organizations (ACOs). However, the challenges of HIT use in ACOs for the management of chronic diseases among Medicare beneficiaries remain less examined.
Purpose: Given the high costs of implementing HIT and the occurrence of multiple chronic conditions (MCC) among elderly individuals, it is important to understand the extent to which HIT capabilities enable chronic disease management among the Medicare population.
Use of and Steering to Pharmacies Owned by Insurers and Pharmacy Benefit Managers in Medicare.
JAMA Health Forum
January 2025
Department of Population Health Sciences, Weill Cornell Medical College, New York, New York.
Importance: The prevalence of pharmacies owned by integrated insurers and pharmacy benefit managers (PBMs), or insurer-PBMs, is of growing regulatory concern. However, little is known about the role of these pharmacies in Medicare, in which pharmacy network protections may influence market dynamics.
Objective: To evaluate the prevalence of insurer-PBM-owned pharmacies and the extent to which insurer-PBMs steer patients to pharmacies they own in Medicare.
Medicaid Unwinding Experiences in Dual-Eligible Older Adults.
JAMA Health Forum
January 2025
Division of General Internal Medicine, University of Pennsylvania, Philadelphia.
Importance: Dual-eligible older adults rely on Medicaid to pay for Medicare premiums and cost sharing in addition to supplemental services including dental and long-term care. However, the unique experiences of dual-eligible older adults with Medicaid unwinding remain unknown.
Objective: To assess the awareness and experiences of dual-eligible older adults with Medicaid redetermination.
High-Cost Cancer Drug Use in Medicare Advantage and Traditional Medicare.
JAMA Health Forum
January 2025
Department of Health Systems, Management, and Policy, University of Colorado Cancer Center, Aurora.
Importance: Medicare Advantage (MA) plans are designed to incentivize the use of less expensive drugs through capitated payments, formulary control, and preauthorizations for certain drugs. These conditions may reduce spending on high-cost therapies for conditions such as cancer, a condition that is among the most expensive to treat.
Objective: To determine whether patients insured by MA plans receive less high-cost drugs than those insured by traditional Medicare (TM).
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!