Medicare Projects

New Developments in Medicare

Check-up Medicare finances health care for more than 45 million enrollees. As a result, it plays a key role in the health and financial well-being of almost 15 percent of the U.S. population and will consume more than $500 billion in 2010. Its size also means that it has a strong influence on how care is delivered throughout the country, and its influence can be felt throughout the health care system. As our population ages and its expenditures rise, Medicare will take on even greater significance and attract more scrutiny. In particular, there is likely to be increasing attention devoted to improving the efficiency and quality of the health care Medicare funds so that the program can continue to fulfill its mission without pushing the government budget more deeply into the red.

Mathematica is at the forefront of studying how the Medicare program can meet its growing challenges. Since much of Medicare's costs go toward people with chronic diseases, we are assessing the effectiveness of coordinated care and disease management programs in improving outcomes and reducing costs for this group. We are also helping the Centers for Medicare & Medicaid Services (CMS) assess the quality of care provided in different settings. To inform debates leading up to the passage of the Medicare prescription drug benefit, we estimated the costs and structure of such a benefit, using information from Medicare beneficiaries who also have Medicaid coverage. We are studying health plan and provider participation and implications for beneficiary access in the Medicare Advantage program.

Coordinated Care and Disease Management

Care coordination and disease management programs were designed to improve care and reduce the Medicare expenditures of beneficiaries with multiple chronic conditions. We have conducted several evaluations to determine the effectiveness of these programs in improving outcomes and reducing health care spending. Recent work has shown that care coordination programs may save money if targeted toward the highest risk patients, but do not in general result in cost savings. We are also investigating payment incentives that encourage providers and insurers to offer these services.

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 are evaluating pay-for-performance incentives to encourage physicians who treat Medicare beneficiaries to adopt a health information technology. We recently completed a study of how well health information technology can achieve its goals through our evaluation of the Informatics for Diabetes Education and Telemedicine (IDEATel) Demonstration.

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.

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 conducted several studies related to these plans. Recently, we assessed the implementation of Medicare Advantage (MA) Special Needs Plans (SNPs), which target their services toward certain types of beneficiaries. We are conducting a number of studies to provide policymakers and the public with timely information about the role of private plans in Medicare. We are analyzing trends in Medicare Advantage benefits and premiums, as well as changes in health plan participation as the program evolves. 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, as we have done in the past with our evaluations of the Program of All-Inclusive Care for the Elderly (PACE) and Social Health Maintenance Organizations, designed to improve care in the community for frail Medicare beneficiaries.

Dual Eligible Beneficiaries

Medicare beneficiaries who are also eligible for Medicaid, so-called "dual eligibles," are a vulnerable population, as evidenced by their disproportionately high medical spending, long-term care needs, and low incomes. We designed and developed a research-quality database on this population in 12 states, 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. We are also estimating the effect of eliminating the two-year Medicare waiting period for Social Security Disability Insurance (SSDI) beneficiaries.

Prescription Drugs

In 2003, Congress passed the Medicare Modernization Act (MMA), authorizing CMS to develop plans to incorporate a prescription drug plan into the Medicare program. Medicare Part D was implemented in 2006, and as policymakers made decisions about this benefit, they needed timely information on prescription drug spending and the market for private prescription drug plans. Our studies analyzed Medicare beneficiaries' access to prescription drugs and spending on prescriptions by individuals dually eligible for Medicare and Medicaid. We also studied market areas for the plans that provide Part D benefits and are evaluating the Medicare replacement drug demonstration. We assisted CMS in identifying best practices in helping low-income beneficiaries enroll in the Part D program.