Stuart Guterman

Using Medicare Payment Policy To Transform The Health System: A Framework For Improving Performance

As the largest payer for health services in the United States, Medicare has the potential to use its payment policies to stimulate change in the organization of care to improve quality and mitigate cost growth. This paper proposes a framework in which Medicare would offer an array of new bundled payment options for physician group practices, hospitals, and delivery systems, with incentives to encourage greater integration in the organization of health care delivery and the provision of more coordinated care to beneficiaries. These changes could also serve as a model for other payers to improve quality and efficiency throughout the health system.

Innovation In Medicare And Medicaid Will Be Central To Health Reform’s Success

The health reform legislation signed into law by President Barack Obama contains numerous payment reform provisions designed to fundamentally transform the nations health care system. Perhaps the most noteworthy of these is the establishment of a Center for Medicare and Medicaid Innovation within the Centers for Medicare and Medicaid Services. This paper presents recommendations that would maximize the new centers effectiveness in promoting reforms that can improve the quality and value of care in Medicare, Medicaid, and the Childrens Health Insurance Program, while helping achieve health reforms goals of more efficient, coordinated, and effective care.

Prescription Coverage, Use and Spending Before and After Part D Implementation: A National Longitudinal Panel Study

BACKGROUNDIn January 2006, 43 million Medicare beneficiaries became eligible for subsidized prescription coverage (Part D) through Medicare. To date, no longitudinal study has afforded information on beneficiaries’ prescription coverage transitions and corresponding changes in prescription use and spending.OBJECTIVETo evaluate changes in Medicare beneficiaries’ prescription coverage, use and spending before and after Part D implementation, including comparison of those who enrolled in Part D with those who did not.DESIGN, SETTING AND PARTICIPANTSLongitudinal observational study of non-institutionalized Medicare beneficiaries aged 65 and older (n = 9,573) employing administrative data from the Centers for Medicare and Medicaid Services (CMS) and survey-based data from beneficiaries (2003, 2006). Sampling drew from a 1% national probability sample (2003), oversampling low-income beneficiaries including those dually-enrolled in Medicare and Medicaid.MEASUREMENTS & MAIN RESULTSNumber and type of prescriptions, monthly out-of-pocket prescription spending, and cost-related non-adherence to prescription regimens. Most respondents who lacked prescription coverage in 2003 had acquired it by 2006 (82.6%)—primarily through Part D (63.1%). Part D enrollees who previously lacked coverage or had Medigap coverage appear particularly advantaged by Part D, as evidenced by significantly increased prescription use, lower out-of-pocket spending and lower non-adherence. Those with employer-based coverage experienced significantly increased spending. Among those still lacking coverage in 2006, high rates of cost-related non-adherence (31.8%) were reported by the low-income, chronically ill subgroup.CONCLUSIONSIn its first year, Part D coverage appears to have moderated prescription spending and cost-related burden for those who previously had meager benefits or none. Increased spending among those with employer-based coverage may reflect a narrowing of those benefits over this period. Evidence of foregone care among low-income, chronically ill seniors who still lack prescription coverage highlights the importance of targeted outreach to this group for Part D’s low-income subsidy program.

Medicare at 50 — Origins and Evolution

In part one of a two-part report marking the 50th anniversary of Medicare, the authors review the history of the programs passage into law and how it has been modified over the past five decades. Part two will cover proposals to address Medicares ongoing challenges.

Medicare at 50 — Moving Forward

In this Health Policy Report marking the 50th anniversary of Medicare, the authors review several potential strategies for addressing the challenges to the effectiveness and sustainability of the program.

The “Doc Fix” — Another Missed Opportunity

Congress has once again temporarily overridden Medicares physician-fee cuts mandated by the sustainable growth rate formula, rather than permanently eliminating the formula. But recent bills providing a permanent fix may provide hope for more definitive action soon.

Medicare Essential: An Option To Promote Better Care And Curb Spending Growth

Medicares core benefit design reflects private insurance as of 1965, with separate coverage for hospital and physician services (and now prescription drugs) and no protection against catastrophic costs. Modernizing Medicares benefit design to offer comprehensive benefits, financial protection, and incentives to choose high-value care could improve coverage and lower beneficiary costs. We describe a new option we call Medicare Essential, which would combine Medicares hospital, physician, and prescription drug coverage into an integrated benefit with an annual limit on out-of-pocket expenses for covered benefits. Cost sharing would be reduced for enrollees who seek care from high-quality low-cost providers. Out-of-pocket savings from lower premiums and health care costs for a Medicare Essential enrollee could be

Meeting enrollees' needs: how do Medicare and employer coverage stack up?

173 per month, compared to what an enrollee would pay with traditional Medicare, prescription drug and private supplemental coverage. Financed by a budget-neutral premium, we estimate that this new plan choice could reduce total health spending relative to current projections by

Getting from Here to There in Payment Reform: Necessary Practices and Policies

180 billion and reduce employer retiree spending by

Medicare Prescription Drug Benefit Progress Report: Findings From A 2006 National Survey Of Seniors

90 billion during 2014-23. Given its potential, such an alternative should be a part of the debate over the future of Medicare.