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Government And Commercial Insurer Payment Rates to Hospitals: A Commentary on Priselac
Paul Ginsburg from discusses how for decades, stakeholders have argued about whether competition or regulation should be the approach to constrain health care spending. By having chosen neither, he argues, our nation now finds itself with a much larger challenge. The magnitude of our health care affordability problem cries out for pursuing both competition and regulation.
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Healthcare Utilization Before and After a Dementia Diagnosis in Medicare Advantage Versus Traditional Medicare
The increase in care use leading up to a dementia diagnosis is higher among beneficiaries in traditional Medicare than in Advantage plans and remains higher after diagnosis.
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White House Names First 10 Drugs for Medicare Negotiations; USC Policy Experts Available to Discuss Market Impact
Medicare released the list of the first 10 drugs subject to price negotiations under the Inflation Reduction Act (IRA), aiming to reduce drug costs for Medicare enrollees and taxpayers.
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Estimates of Diagnosed Dementia Prevalence and Incidence Among Diverse Beneficiaries in Traditional Medicare and Medicare Advantage
The prevalence of diagnosed dementia among beneficiaries in MA was lower than in TM.
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The nation’s growing debt threatens Medicare and Medicaid, which have helped countless Americans and reduced poverty. Schaeffer Center researchers work with legislators on a bipartisan basis to bolster these vital systems, making them more efficient and effective.
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Comments to CMS on Proposed Guidance for Coverage with Evidence Development
Eleven Schaeffer fellows cosigned a comment letter to Centers for Medicaid and Medicare Services providing recommendations on the proposed Coverage with Evidence Development Guidance.
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Lowering Medicare Advantage Overpayments from Favorable Selection by Reforming Risk Adjustment
One potential path for reducing Medicare Advantage (MA) overpayments from favorable selection is reforming the current administered payment approaches linking spending in fee-for-service (FFS) to MA rates.
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Trends in the Level and Composition of Supplemental Benefits in Medicare Advantage
The study evaluates the growth in rebates and concomitant changes in supplemental benefit composition among health maintenance organizations (HMOs) and local preferred provider organizations (PPOs).
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Favorable Selection Ups the Ante on Medicare Advantage Payment Reform
Overpayment to Medicare Advantage plans due to favorable selection, “coding intensity” and rating bonuses could exceed $75B in 2023.
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Overpayments to Medicare Advantage Plans Could Exceed $75 Billion in 2023, USC Schaeffer Center Research Finds
Overpayments to Medicare Advantage plans now exceed 20% annually, underscoring the urgent need for reform.
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Medicare Advantage Enrolls Lower-Spending People, Leading to Large Overpayments
Favorable selection led to Medicare Advantage overpayments on the order of 14.4% in 2020.
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