DOES MANAGED CARE REDUCE PREVENTABLE HOSPITALIZATIONS IN THE MEDICARE POPULATION? THE IMPACT OF MEDICARE ADVANTAGE ON AMBULATORY CARE SENSITIVE HOSPITAL ADMISSIONS AND USE OF PREVENTIVE SERVICES

DOES MANAGED CARE REDUCE PREVENTABLE HOSPITALIZATIONS IN THE MEDICARE POPULATION? THE IMPACT OF MEDICARE ADVANTAGE ON AMBULATORY CARE SENSITIVE HOSPITAL ADMISSIONS AND USE OF PREVENTIVE SERVICES PDF Author: Gregory Berger
Publisher:
ISBN:
Category : Economics
Languages : en
Pages : 134

Get Book Here

Book Description
One controversial option to control growth in the rate of federal spending on health care is to transform Medicare into a "voucher" program for beneficiaries to purchase health insurance from managed care plans in the private market. Approximately one-quarter of Medicare beneficiaries are currently enrolled in a private health plan through Medicare Advantage, which has higher average costs than the traditional fee-for-service program but potentially reduces costly and unnecessary medical services by increasing the use of preventive care. Using a nationally representative sample of Medicare beneficiaries from the Medical Expenditure Panel Survey (MEPS) from 2006 to 2010, I compared the prevalence of potentially avoidable hospital admissions and use of preventive services for beneficiaries in Medicare Advantage to beneficiaries in the traditional fee-for-service program. Using propensity score estimation to control for observable bias, I found no relationship between enrollment in Medicare Advantage and potentially avoidable hospital admissions, and a significant but small positive relationship with use of select preventive services. Considered together, these findings suggest that Medicare Advantage may not achieve better health outcomes for beneficiaries than the traditional fee-for-service program. These findings have implications for policy discussions surrounding the future expansion of private managed care plans in the Medicare program.

DOES MANAGED CARE REDUCE PREVENTABLE HOSPITALIZATIONS IN THE MEDICARE POPULATION? THE IMPACT OF MEDICARE ADVANTAGE ON AMBULATORY CARE SENSITIVE HOSPITAL ADMISSIONS AND USE OF PREVENTIVE SERVICES

DOES MANAGED CARE REDUCE PREVENTABLE HOSPITALIZATIONS IN THE MEDICARE POPULATION? THE IMPACT OF MEDICARE ADVANTAGE ON AMBULATORY CARE SENSITIVE HOSPITAL ADMISSIONS AND USE OF PREVENTIVE SERVICES PDF Author: Gregory Berger
Publisher:
ISBN:
Category : Economics
Languages : en
Pages : 134

Get Book Here

Book Description
One controversial option to control growth in the rate of federal spending on health care is to transform Medicare into a "voucher" program for beneficiaries to purchase health insurance from managed care plans in the private market. Approximately one-quarter of Medicare beneficiaries are currently enrolled in a private health plan through Medicare Advantage, which has higher average costs than the traditional fee-for-service program but potentially reduces costly and unnecessary medical services by increasing the use of preventive care. Using a nationally representative sample of Medicare beneficiaries from the Medical Expenditure Panel Survey (MEPS) from 2006 to 2010, I compared the prevalence of potentially avoidable hospital admissions and use of preventive services for beneficiaries in Medicare Advantage to beneficiaries in the traditional fee-for-service program. Using propensity score estimation to control for observable bias, I found no relationship between enrollment in Medicare Advantage and potentially avoidable hospital admissions, and a significant but small positive relationship with use of select preventive services. Considered together, these findings suggest that Medicare Advantage may not achieve better health outcomes for beneficiaries than the traditional fee-for-service program. These findings have implications for policy discussions surrounding the future expansion of private managed care plans in the Medicare program.

Care Without Coverage

Care Without Coverage PDF Author: Institute of Medicine
Publisher: National Academies Press
ISBN: 0309083435
Category : Medical
Languages : en
Pages : 213

Get Book Here

Book Description
Many Americans believe that people who lack health insurance somehow get the care they really need. Care Without Coverage examines the real consequences for adults who lack health insurance. The study presents findings in the areas of prevention and screening, cancer, chronic illness, hospital-based care, and general health status. The committee looked at the consequences of being uninsured for people suffering from cancer, diabetes, HIV infection and AIDS, heart and kidney disease, mental illness, traumatic injuries, and heart attacks. It focused on the roughly 30 million-one in seven-working-age Americans without health insurance. This group does not include the population over 65 that is covered by Medicare or the nearly 10 million children who are uninsured in this country. The main findings of the report are that working-age Americans without health insurance are more likely to receive too little medical care and receive it too late; be sicker and die sooner; and receive poorer care when they are in the hospital, even for acute situations like a motor vehicle crash.

The Spillover Effects of Medicare Managed Care

The Spillover Effects of Medicare Managed Care PDF Author: Katherine Baicker
Publisher:
ISBN:
Category : Economics
Languages : en
Pages : 0

Get Book Here

Book Description
More than a quarter of Medicare beneficiaries are enrolled in Medicare Advantage, which was created in large part to improve the efficiency of health care delivery by promoting competition among private managed care plans. This paper explores the spillover effects of the Medicare Advantage program on the traditional Medicare program and other patients, taking advantage of changes in Medicare Advantage payment policy to isolate exogenous increases in Medicare Advantage enrollment and trace out the effects of greater managed care penetration on hospital utilization and spending throughout the health care system. We find that when more seniors enroll in Medicare managed care, hospital costs decline for all seniors and for commercially insured younger populations. Greater managed care penetration is not associated with fewer hospitalizations, but is associated with lower costs and shorter stays per hospitalization. These spillovers are substantial - offsetting more than 10% of increased payments to Medicare Advantage plans.

Free for All?

Free for All? PDF Author: Joseph P. Newhouse
Publisher:
ISBN: 9780674319141
Category : Business & Economics
Languages : en
Pages : 489

Get Book Here

Book Description
From 1971 to 1982, researchers at the RAND Corporation devised an experiment to address two key questions in health care financing: how much more medical care will people use if it is provided free of charge? and what are the consequences for their health? This book presents a comprehensive account of the experiment and its findings. It will be an invaluable teaching tool and reference for anyone concerned with health-care policy.

Modeling the Impact of Medicare Advantage Payment Cuts on Ambulatory Care Sensitive and Elective Hospitalizations

Modeling the Impact of Medicare Advantage Payment Cuts on Ambulatory Care Sensitive and Elective Hospitalizations PDF Author: Lauren Hersch Nicholas
Publisher:
ISBN:
Category :
Languages : en
Pages : 0

Get Book Here

Book Description
Objective. To assess relationships between changes in Medicare Advantage (MA) payment rates and Medicare beneficiary hospitalizations and to simulate the effects of scheduled payment cuts on ambulatory care sensitive and elective hospitalization rates. Data. State Inpatient Database discharge abstracts from Arizona, Florida, and New York merged with administrative Medicare enrollment and MA payment data. Study Design. Retrospective, fixed effect regression analysis of the relationship between Medicare Advantage payment rates and rates of ambulatory care sensitive and elective hospitalizations amongst Medicare beneficiaries in counties with at least 10,000 Medicare beneficiaries and 3 percent MA penetration from 1999 - 2005. Principal Findings. MA payment rates were negatively related to rates of ACS admissions. Simulations suggest that payment cuts could be associated with higher rates of ACS admissions. No relationship between MA payments and rates of elective hospitalizations was found. Conclusions. Reductions in Medicare Advantage payment rates may result in a small increase in ambulatory care sensitive admissions. Trends in ambulatory care sensitive admissions amongst chronically ill Medicare beneficiaries should be tracked following MA payment cuts.

Envisioning the National Health Care Quality Report

Envisioning the National Health Care Quality Report PDF Author: Institute of Medicine
Publisher: National Academies Press
ISBN: 030907343X
Category : Medical
Languages : en
Pages : 257

Get Book Here

Book Description
How good is the quality of health care in the United States? Is quality improving? Or is it suffering? While the average person on the street can follow the state of the economy with economic indicators, we do not have a tool that allows us to track trends in health care quality. Beginning in 2003, the Agency for Healthcare Research and Quality (AHRQ) will produce an annual report on the national trends in the quality of health care delivery in the United States. AHRQ commissioned the Institute of Medicine (IOM) to help develop a vision for this report that will allow national and state policy makers, providers, consumers, and the public at large to track trends in health care quality. Envisioning the National Health Care Quality Report offers a framework for health care quality, specific examples of the types of measures that should be included in the report, suggestions on the criteria for selecting measures, as well as advice on reaching the intended audiences. Its recommendations could help the national health care quality report to become a mainstay of our nation's effort to improve health care.

Patient Safety and Quality

Patient Safety and Quality PDF Author: Ronda Hughes
Publisher: Department of Health and Human Services
ISBN:
Category : Medical
Languages : en
Pages : 592

Get Book Here

Book Description
"Nurses play a vital role in improving the safety and quality of patient car -- not only in the hospital or ambulatory treatment facility, but also of community-based care and the care performed by family members. Nurses need know what proven techniques and interventions they can use to enhance patient outcomes. To address this need, the Agency for Healthcare Research and Quality (AHRQ), with additional funding from the Robert Wood Johnson Foundation, has prepared this comprehensive, 1,400-page, handbook for nurses on patient safety and quality -- Patient Safety and Quality: An Evidence-Based Handbook for Nurses. (AHRQ Publication No. 08-0043)." - online AHRQ blurb, http://www.ahrq.gov/qual/nurseshdbk/

Systems Practices for the Care of Socially At-Risk Populations

Systems Practices for the Care of Socially At-Risk Populations PDF Author: National Academies of Sciences, Engineering, and Medicine
Publisher: National Academies Press
ISBN: 0309391970
Category : Medical
Languages : en
Pages : 95

Get Book Here

Book Description
The Centers for Medicare & Medicaid Services (CMS) have been moving from volume-based, fee-for-service payment to value-based payment (VBP), which aims to improve health care quality, health outcomes, and patient care experiences, while also controlling costs. Since the passage of the Patient Protection and Affordable Care Act of 2010, CMS has implemented a variety of VBP strategies, including incentive programs and risk-based alternative payment models. Early evidence from these programs raised concerns about potential unintended consequences for health equity. Specifically, emerging evidence suggests that providers disproportionately serving patients with social risk factors for poor health outcomes (e.g., individuals with low socioeconomic position, racial and ethnic minorities, gender and sexual minorities, socially isolated persons, and individuals residing in disadvantaged neighborhoods) may be more likely to fare poorly on quality rankings and to receive financial penalties, and less likely to receive financial rewards. The drivers of these disparities are poorly understood, and differences in interpretation have led to divergent concerns about the potential effect of VBP on health equity. Some suggest that underlying differences in patient characteristics that are out of the control of providers lead to differences in health outcomes. At the same time, others are concerned that differences in outcomes between providers serving socially at-risk populations and providers serving the general population reflect disparities in the provision of health care. Systems Practices for the Care of Socially At-Risk Populations seeks to better distinguish the drivers of variations in performance among providers disproportionately serving socially at-risk populations and identifies methods to account for social risk factors in Medicare payment programs. This report identifies best practices of high-performing hospitals, health plans, and other providers that serve disproportionately higher shares of socioeconomically disadvantaged populations and compares those best practices of low-performing providers serving similar patient populations. It is the second in a series of five brief reports that aim to inform the Office of the Assistant Secretary of Planning and Evaluation (ASPE) analyses that account for social risk factors in Medicare payment programs mandated through the Improving Medicare Post-Acute Care Transformation (IMPACT) Act.

Retooling for an Aging America

Retooling for an Aging America PDF Author: Institute of Medicine
Publisher: National Academies Press
ISBN: 0309131952
Category : Medical
Languages : en
Pages : 316

Get Book Here

Book Description
As the first of the nation's 78 million baby boomers begin reaching age 65 in 2011, they will face a health care workforce that is too small and woefully unprepared to meet their specific health needs. Retooling for an Aging America calls for bold initiatives starting immediately to train all health care providers in the basics of geriatric care and to prepare family members and other informal caregivers, who currently receive little or no training in how to tend to their aging loved ones. The book also recommends that Medicare, Medicaid, and other health plans pay higher rates to boost recruitment and retention of geriatric specialists and care aides. Educators and health professional groups can use Retooling for an Aging America to institute or increase formal education and training in geriatrics. Consumer groups can use the book to advocate for improving the care for older adults. Health care professional and occupational groups can use it to improve the quality of health care jobs.

Our Parents, Ourselves

Our Parents, Ourselves PDF Author: Judith Steinberg Turiel
Publisher: Univ of California Press
ISBN: 0520245245
Category : Family & Relationships
Languages : en
Pages : 319

Get Book Here

Book Description
"Our Parents, Ourselves is the best presentation of our aging, and of general healthcare issues that I have ever seen. Tremendously important."—Henrik Blum, M.D., MPH, Professor Emeritus, School of Public Health, University of California, Berkeley "This book could well transform how we as a country address aging and caregiving for generations to come."—Lynn Friss Feinberg, MSW, Deputy Director, National Center on Caregiving at Family Caregiver Alliance "Turiel's book can help elders and their families find humane care in our often inhumane and uncaring health care system."— Steffi Woolhandler, co-founder of Physicians for a National Health Program