New Developments in Medicare

More resources are needed to sustain the Medicare program as baby boomers retire and the elderly and disabled population expands. Mathematica is at the forefront of studying how Medicare is changing and meeting the needs of beneficiaries. We are assessing health plan and provider participation and implications for beneficiary access in the Medicare Advantage program (previously Medicare+Choice). To inform debates leading up to 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. Since much of Medicare's costs go toward people with chronic diseases, we evaluate the effectiveness of chronic disease management programs as well as ways of paying for them. We are also helping the Centers for Medicare & Medicaid Services (CMS) assess the quality of care provided in different settings.

Private Health Plans

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 Medicare HMOs and other private plans. In addition, we continue to evaluate new models, such as Social Health Maintenance Organizations, designed to improve care in the community for frail Medicare beneficiaries.

Coordinated Care and Disease Management

Care coordination and disease management programs are innovative initiatives for Medicare beneficiaries with chronic illnesses. Mathematica is conducting 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.

Dual Eligibles

Medicare beneficiaries who are also eligible for Medicaid, so-called “dual eligibles,” are a vulnerable population because of their disproportionately high medical and long-term care needs and their low incomes. We designed and developed a research-quality database on this population in 12 states, which is 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 that eliminating the two-year Medicare waiting period for people receiving Social Security Disability Insurance (SSDI) and adding a Medicare prescription drug benefit would have on Medicaid and Medicare expenditures. In addition, we are evaluating the Program of All-Inclusive Care for the Elderly (PACE), which integrates preventive, acute, and long-term care.

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 medical care funded by the Medicare program and a hospital-level public reporting system for CMS. 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.

Prescription Drugs

In 2003, Congress passed the Medicare Modernization Act (MMA), authorizing CMS to develop plans to incorporate a prescription drug benefit into the Medicare program. As policymakers make decisions about these benefits, they need timely information on prescription drug spending and the market for private prescription drug plans. Our studies have analyzed Medicare beneficiaries' access to prescription drugs, and spending on prescriptions by individuals who are dually eligible for Medicare and Medicaid. We are studying market areas for the plans that will provide Part D benefits to Medicare beneficiaries beginning in 2006 and evaluating the Medicare replacement drug demonstration. We are also helping CMS identify best practices in helping low-income beneficiaries enroll in the Part D program.

Health Information Technology

The U.S. health care system is undergoing a rapid transformation as information technology is adopted to improve quality of care, reduce medical errors, and lessen administrative costs. We are studying how well health information technology can achieve these goals through our evaluation of the Informatics for Diabetes Education and Telemedicine (IDEATel ) Demonstration. In addition, we convened an expert panel to discuss recent changes in medical practice. We are also evaluating pay-for-performance incentives to encourage physicians who treat Medicare beneficiaries to adopt health information technology.