This report examines the variation in Medigap premiums, recent trends in premium growth and policies that experience relatively high premium growth. The report also compares the premium growth over different segments of the entire time period studied, and to changes in enrollment in both Medigap policies and the Medicare Advantage Program. [38 PDF pages]

This project expands ASPE's Medicare post-acute care (PAC) episode analytic file in terms of sample size and the number of years used (2006-2008) to provide more detailed characteristics of PAC episodes under different definitions. This analysis provides information on changes in PAC use, allows for more detailed understanding of the patterns of PAC use by geography, and provides a cross-sectional and longitudinal analysis. In addition, this work uses acute Medicare hospital and community entrant initiated episode definitions.

The purpose of this project is to continue the ASPE bundling research in the area of Medicare post acute care using the 2006 Medicare post acute episode file developed in the previous analysis. This project considers 18 alternative Medicare acute hospital plus post-acute care episode definitions, models the impact on potential payment bundles, and examines differences in payments by geographic area using standardized payments. [36 PDF pages]

Medicare Advantage (MA) is the current program under which beneficiaries can enroll in private health plans rather than having their care covered through Medicare's traditional fee for service (FFS) program. Payments to MA plans in many areas are now substantially greater than the cost of treating comparable beneficiaries in the traditional program. The higher payments have raised serious questions regarding Medicare's fiscal solvency, their net value to the program and their equity implications for beneficiaries. In this paper, we provide a detailed description of the MA program, describe the issues related to the MA payment debate, and analyze options that might be considered for modifying the current methods of determining MA payment amounts. [48 PDF pages]

This project continues the analysis of Medicare beneficiary level episodes of post-acute care. RTI builds on its previously funded ASPE project by expanding the episode file to include 2006 claims. The episode definition initiates with an acute hospital stay and includes all Medicare post acute care services (e.g., long-term care hospitals, skilled nursing facilities, home health agencies, inpatient rehabilitation facilities, outpatient therapy), Part B services, hospice and durable medical equipment. The analysis provides trends on transfer patterns, average payments, average readmission rates, severity of illness factors and other descriptive characteristics of Medicare post acute care users. [118 PDF pages]

This project examines alternative episode definitions to better align performance measures, incentives, payments, and accountability within Medicare fee-for service in the near term and options for broader episode-based reforms. The project includes an environmental scan, a technical expert panel for review and input of deliverables in the project, analyses of grouped Medicare claims data, and the development of a conceptual analytic piece. [245 PDF pages]

This project developed an inventory of Quality Improvement Program (QIO) activities and then proposed methodologies to evaluate Medicare's QIO in the future. The contractor gathered information from publicly available sources, from CMS data when available, and from nine site visits to a variety of QIOs. Based on the findings, NORC developed a list of potential projects to evaluate the QIO program. These were presented to a Technical Expert Panel, who provided input on their feasibility and priority. NORC used this information to prepare a report describing potential evaluation approaches.

This project reports on analysis using linked Medicaid and FEHBP data examining refinements to the risk adjustment factors for drug plans for low income and institutionalized populations; geographic variation in drug spending by health plan area; and prior use models of drug plan risk-adjustment. [77 PDF pages]

This project examines the Medicare Advantage (MA) products available in 2006, how they compare to past offerings when only local MA options were authorized, initial plan decisions and experiences under the new competitive bidding process, and how well available offers and enrollment meet Congress's overall objectives in enacting the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). [117 PDF pages]

The purpose of this study was to evaluate the current system of financing for graduate medical education (GME) and to assess the strengths and weaknesses of alternative methods for GME financing. In completing the project researchers from RAND performed a literature review and held discussions with experts in the United States and abroad. The study identified a number of ways in which the Medicare program's support for GME could be improved. Most of these improvements center on changes to the formulas used to determine the level of payments Medicare makes to teaching hospitals. The report also identified five elements on which to evaluate any alternatives to the current system equity, adequacy, efficiency, accountability, and administrative feasibility. The report made no specific recommendations. [183 PDF pages]