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Medicare Topics
- Cost Control and Payment Method Reform
- Quality and Access to Care
- Coordinated Care and Disease Management
- Health Information Technology
- Dual Eligible Beneficiaries
- Prescription Drugs
- Managed Care and Private Health Plans
Medicare Projects
New Developments in Medicare
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Mathematica brings the highest standards of quality, objectivity and excellence to bear on the collection and analysis of information about Medicare. We are at the forefront of studying how the Medicare program can meet its growing challenges, and we are working to improve public wellbeing with clients including CMS in areas such as: |
Cost Control and Payment Method Reform
With an aging population, increasing pressure on Medicare costs can be expected to bring more attention to options for Medicare reform. Mathematica is working on various projects to help inform strategies for controlling Medicare costs and increasing efficiency.
Recent projects:
Modeling the Impact of Medicare and Broader Payment Reform Initiatives
Development of Resource Use Reports for Medicare Fee-for-Service Claims
Development of Physician Quality and Resource Use Reports Using Medicare Fee-for-Service Beneficiary Data
Recent publications:
"Using Payment Incentives to Improve Care for the Chronically Ill in Medicare: First Year Implementation of the Medicare Care Management Performance Demonstration (MCMP)" (March 2009)
"Medicare Governance and Provider Payment Policy" (October 2009)
"Strategies for Reining in Medicare Spending Through Delivery System Reforms: Assessing the Evidence and Opportunities" (September 2009)
More on cost control and payment method reform
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Quality and Access to Care
Health care quality and access are two of the most pressing challenges facing the U.S. health care system. We are currently developing indicators of the quality of Medicare-funded medical care delivered by hospitals and physicians and have helped CMS implement a hospital-level public reporting system. We are also assessing whether prospective payment systems affect beneficiaries' access to skilled nursing facility care. Drawing on our expertise in survey research, we are working to design and implement a targeted beneficiary survey on access to physician services.
Recent projects:
Assessment of Disparities in Potentially Avoidable Hospitalizations of Maryland Medicare Patients
ARRA HITECH Eligible Professional (EP) Clinical Quality Measures
Program Evaluation of the Eighth and Ninth Scope of Work Quality Improvement Program
Recent publications:
"Promising Therapies, Prohibitive Costs: A Qualitative Assessment of the Effects of the Medicare Part D Doughnut Hole on Access to Costly Cancer Medications" (March 2011)
"Quality and Resource Use Reports (QRURs): Frequently Asked Questions" (October 2010)
"Evaluation of Medicare Part D Late Enrollment Penalty Demonstration for Low-Income Subsidy Applicants and Residents Affected by Hurricane Katrina" (September 2010)
More on quality and access to care
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Coordinated Care and Disease Management
Since much of Medicare's costs go toward people with chronic diseases, we are assessing the effectiveness of coordinated care and disease management programs. We have conducted several evaluations to determine the effectiveness of these programs in improving outcomes and reducing health care spending. We are also investigating payment incentives that encourage providers and insurers to offer these services.
Recent projects:
Federal Facilitation of the Patient Centered Medical Home (PCMH) Model
Evaluation Design for the UnitedHealth Group Medical Home Pilot
Establishing Federal Resources to Support the Patient Centered Medical Home
Recent publications:
"Comparative Effectiveness of Care Coordination for Adults with Disabilities" (July 2011)
"Defining the Role of SNPs in 2011 and 2012" (June 2011)
"Features of Successful Care Coordination Programs" (December 2009)
More on coordinated care and disease management
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Health Information Technology
The U.S. health care system is undergoing a rapid transformation as information technology is adopted to improve the quality of care, reduce medical errors, and lessen administrative costs. We have evaluated pay-for-performance incentives to encourage physicians who treat Medicare beneficiaries to adopt a health information technology. We have also studied how well health information technology can achieve its goals.
Recent projects:
Global Assessment of the Value of Health Information Technology (HIT) and Office of the National Coordinator for Health Information Technology (ONC) Programs
Evaluation of Medicare Personal Health Records Choice Pilot
Evaluation of the Informatics, Telemedicine, and Education Demonstration: Phase II
Recent publications:
"Could There Be a Role for Home Telemedicine in the U.S. Medicare Program?" (March 2011)
"Medicare Incentives for Using EHRs: Insights from Site Visits to Small and Mid-Sized Physician Practices" (June 2010)
"Costs to Medicare of the IDEATel Home Telemedicine Demonstration: Findings from an Independent Evaluation" (July 2009)
More on health information technology
Dual Eligible Beneficiaries
Medicare beneficiaries who are also eligible for Medicaid, "dual eligibles," have high levels of medical spending, long-term care needs, and low incomes. We have developed a research-quality database on this population, larger and more detailed than any other database previously assembled on this population. We are studying the role of Medicare and Medicaid in financing home health care for dual eligibles, and examining each program's share of expenditures for this population in nursing homes.
Recent projects:
Prepare Data on Medicaid and Medicare Spending on Dual Eligible Beneficiaries in 2006
Evaluation of Medicare Advantage Special Needs Plans
Provide technical assistance to states to improve quality of services, reduce disparities and increase community options for people with disabilities
Recent publications:
"Managing the Care of Dual Eligible Beneficiaries: A Review of Selected State Programs and Special Needs Plans" (June 2011)
"Integrating Care for Dual Eligibles: Capitated Managed Care Options" (October 2010)
"Including Medicare-Medicaid Dual Eligibles in Managed Care: Current Status and Future Prospects" (July 2010)
More on dual eligible beneficiaries
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Prescription Drugs
Since Medicare Part D was implemented in 2006, policymakers have needed timely information on prescription drug spending and the market for private prescription drug plans. Our studies analyze Medicare beneficiaries' access to prescription drugs and spending on prescriptions. We have also studied market areas for the plans that provide Part D benefits and the Medicare replacement drug demonstration.
Recent projects:
Evaluation of the Medicare Payment Demonstration for Medicare Part D Retroactive and Point-of-Sale Coverage for Certain Low-Income Beneficiaries
Best Practices for Enrolling Low-Income Beneficiaries into the Medicare Prescription Drug Benefit Program
Recent publications:
"Tracking Medicare Health and Prescription Drug Plans: Monthly Report for May 2011"
"Out-of-Pocket Drug Costs and Drug Utilizaiton Patterns of Postmenopausal Medicare Beneficiaries with Osteoporosis" (May 2011)
"An Assessment of the Impact of an Educational Pharmacy Management Intervention on Prescribers to Medicaid Beneficiaries" (June 2009)
More on prescription drugs
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Managed Care and Private Health Plans
Medicare beneficiaries have the choice to enroll in managed care plans instead of traditional fee-for-service Medicare, and many of those with fee-for-service plans choose to supplement their coverage by purchasing private Medigap plans. We have assessed the implementation of Medicare Advantage (MA) Special Needs Plans (SNPs), which target their services toward certain types of beneficiaries, and have analyzed trends in Medicare Advantage benefits, premiums, and participation. To make data more readily available, we developed an interactive, online Medicare Health Plan Tracker that provides basic information about MA and private health plans. In addition, we continue to evaluate new Medicare models as they arise.
Recent projects:
Evaluation of the Medicare Care Management Performance Demonstration
Monitoring Medicare Advantage Plans, 2009-2010
Tracking and Analysis of Private Plans in Medicare, 2008-2009
Recent publications:
"Managing the Care of Dual Eligible Beneficiaries: A Review of Selected State Programs and Special Needs Plans" (June 2011)
"Plan Availability and Premiums" (October 2010)
"Plan Enrollment Patterns and Trends" (June 2010)
More on managed care and private health plans
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