Redesigning the Medicare Contract

Redesigning the Medicare Contract

Author: Edward F. Lawlor

Publisher: University of Chicago Press

Published: 2003-12-06

Total Pages: 290

ISBN-13: 9780226470344

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Recent debates on Medicare reform focus on prescription drug coverage, expanding managed-care choices, or technical issues of payment policy. Despite all the heat generated by these issues, Edward F. Lawlor's new book, Redesigning the Medicare Contract, demonstrates that fundamental questions of purpose and policy design for Medicare have been largely ignored. Challenging conventional ideas, Lawlor suggests that we look at Medicare as a contract between the federal government, the program's beneficiaries, and health care providers. Medicare reform, then, would involve rewriting this contract so that it more successfully serves the interests of both beneficiaries and taxpayers. To do this, Lawlor argues that we must improve the agency of the program—the informational, organizational, and incentive elements that assure Medicare program carries out beneficiary and taxpayer interests in providing the most appropriate, high-quality care possible. The book includes a chapter devoted solely to concepts and applications that give definition to this brand of agency theory. Lawlor's innovative agency approach is matched with lucid explanation of the more comprehensive groundwork in the history and politics of the Medicare program. Lawlor's important and timely book reframes the Medicare debate in a productive manner and effectively analyzes alternatives for reform. Lawlor argues that effective policy design for Medicare requires greater appreciation of the vulnerability of beneficiaries, the complexity of the program itself, its wide geographical variations in services and financing, and the realistic possibilities for government and private sector roles. Tackling difficult problems like end-of-life and high-tech care—and offering sensible solutions—Redesigning the Medicare Contract will interest political scientists, economists, policy analysts, and health care professionals alike.


Book Synopsis Redesigning the Medicare Contract by : Edward F. Lawlor

Download or read book Redesigning the Medicare Contract written by Edward F. Lawlor and published by University of Chicago Press. This book was released on 2003-12-06 with total page 290 pages. Available in PDF, EPUB and Kindle. Book excerpt: Recent debates on Medicare reform focus on prescription drug coverage, expanding managed-care choices, or technical issues of payment policy. Despite all the heat generated by these issues, Edward F. Lawlor's new book, Redesigning the Medicare Contract, demonstrates that fundamental questions of purpose and policy design for Medicare have been largely ignored. Challenging conventional ideas, Lawlor suggests that we look at Medicare as a contract between the federal government, the program's beneficiaries, and health care providers. Medicare reform, then, would involve rewriting this contract so that it more successfully serves the interests of both beneficiaries and taxpayers. To do this, Lawlor argues that we must improve the agency of the program—the informational, organizational, and incentive elements that assure Medicare program carries out beneficiary and taxpayer interests in providing the most appropriate, high-quality care possible. The book includes a chapter devoted solely to concepts and applications that give definition to this brand of agency theory. Lawlor's innovative agency approach is matched with lucid explanation of the more comprehensive groundwork in the history and politics of the Medicare program. Lawlor's important and timely book reframes the Medicare debate in a productive manner and effectively analyzes alternatives for reform. Lawlor argues that effective policy design for Medicare requires greater appreciation of the vulnerability of beneficiaries, the complexity of the program itself, its wide geographical variations in services and financing, and the realistic possibilities for government and private sector roles. Tackling difficult problems like end-of-life and high-tech care—and offering sensible solutions—Redesigning the Medicare Contract will interest political scientists, economists, policy analysts, and health care professionals alike.


Medicare's Quality Improvement Organization Program

Medicare's Quality Improvement Organization Program

Author: Institute of Medicine

Publisher: National Academies Press

Published: 2006-09-17

Total Pages: 543

ISBN-13: 0309101085

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Medicare's Quality Improvement Organization Program is the second book in the new Pathways to Quality Health Care series. Focusing on performance improvement, it considers the history, role, and effectiveness of the Quality Improvement Organization (QIO) program and its potential to promote quality improvement within a changing health care delivery environment that includes standardized performance measures and new data collection and reporting requirements. This book carefully examines the QIOs that serve every state as well as the national program that guides and supports them. In addition, it highlights the important roles that a national program with private organizations in each state can play in promoting higher quality care. Medicare's Quality Improvement Organization Program looks closely at the technical assistance role of the QIO program and the need to encourage and support providers to improve their performance. By providing an in-depth assessment of the federal experience with quality improvement and recommendations for program improvement, this book helps point the way for those who strive to create higher quality and better value in health care. Intended for multiple audiences, Medicare's Quality Improvement Organization Program is essential reading for members of Congress, the federal executive branch, the QIOs, health care providers and clinicians, and stakeholder groups.


Book Synopsis Medicare's Quality Improvement Organization Program by : Institute of Medicine

Download or read book Medicare's Quality Improvement Organization Program written by Institute of Medicine and published by National Academies Press. This book was released on 2006-09-17 with total page 543 pages. Available in PDF, EPUB and Kindle. Book excerpt: Medicare's Quality Improvement Organization Program is the second book in the new Pathways to Quality Health Care series. Focusing on performance improvement, it considers the history, role, and effectiveness of the Quality Improvement Organization (QIO) program and its potential to promote quality improvement within a changing health care delivery environment that includes standardized performance measures and new data collection and reporting requirements. This book carefully examines the QIOs that serve every state as well as the national program that guides and supports them. In addition, it highlights the important roles that a national program with private organizations in each state can play in promoting higher quality care. Medicare's Quality Improvement Organization Program looks closely at the technical assistance role of the QIO program and the need to encourage and support providers to improve their performance. By providing an in-depth assessment of the federal experience with quality improvement and recommendations for program improvement, this book helps point the way for those who strive to create higher quality and better value in health care. Intended for multiple audiences, Medicare's Quality Improvement Organization Program is essential reading for members of Congress, the federal executive branch, the QIOs, health care providers and clinicians, and stakeholder groups.


The New Medicare Law

The New Medicare Law

Author: Jerrold J. Hercenberg

Publisher:

Published: 1989

Total Pages: 464

ISBN-13:

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Book Synopsis The New Medicare Law by : Jerrold J. Hercenberg

Download or read book The New Medicare Law written by Jerrold J. Hercenberg and published by . This book was released on 1989 with total page 464 pages. Available in PDF, EPUB and Kindle. Book excerpt:


Designing a Premium Support System for Medicare

Designing a Premium Support System for Medicare

Author: Lyle Nelson

Publisher:

Published: 2006

Total Pages: 68

ISBN-13:

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And introduction -- Traditional Medicare and private health plans -- Issues in designing a premium support system for Medicare -- Health care systems that are similar to premium support -- Potential effects of selected approaches to premium support -- Technical aspects of the analysis -- Supplementary tables.


Book Synopsis Designing a Premium Support System for Medicare by : Lyle Nelson

Download or read book Designing a Premium Support System for Medicare written by Lyle Nelson and published by . This book was released on 2006 with total page 68 pages. Available in PDF, EPUB and Kindle. Book excerpt: And introduction -- Traditional Medicare and private health plans -- Issues in designing a premium support system for Medicare -- Health care systems that are similar to premium support -- Potential effects of selected approaches to premium support -- Technical aspects of the analysis -- Supplementary tables.


Data-Driven Incentive Design in the Medicare Shared Savings Program

Data-Driven Incentive Design in the Medicare Shared Savings Program

Author: Anil Aswani

Publisher:

Published: 2018

Total Pages: 53

ISBN-13:

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The Medicare Shared Savings Program (MSSP) was created under the Patient Protection and Affordable Care Act to control escalating Medicare spending by incentivizing providers to deliver healthcare more efficiently. Medicare providers that enroll in the MSSP earn bonus payments for reducing spending to below a risk-adjusted financial benchmark that depends on the provider's historical spending. To generate savings, a provider must invest to improve efficiency, which is a cost that is absorbed entirely by the provider under the current contract. This has proven to be challenging for the MSSP, with a majority of participating providers unable to generate savings due to the associated costs. In this paper, we propose a predictive analytics approach to redesigning the MSSP contract with the goal of better aligning incentives and improving financial outcomes from the MSSP. We formulate the MSSP as a principal-agent model and propose an alternate contract that includes a performance-based subsidy to partially reimburse the provider's investment. We prove the existence of a subsidy-based contract that dominates the current MSSP contract by producing a strictly higher expected payoff for both Medicare and the provider. We then propose an estimator based on inverse optimization for estimating the parameters of our model. We use a dataset containing the financial performance of providers enrolled in the MSSP, which together accounts for 7 million beneficiaries and over $70 billion in Medicare spending. We estimate that introducing performance-based subsidies to the MSSP can boost Medicare savings by up to 40% without compromising provider participation in the MSSP. We also find that the subsidy-based contract performs well in comparison to a fully flexible, non-parametric contract.


Book Synopsis Data-Driven Incentive Design in the Medicare Shared Savings Program by : Anil Aswani

Download or read book Data-Driven Incentive Design in the Medicare Shared Savings Program written by Anil Aswani and published by . This book was released on 2018 with total page 53 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Medicare Shared Savings Program (MSSP) was created under the Patient Protection and Affordable Care Act to control escalating Medicare spending by incentivizing providers to deliver healthcare more efficiently. Medicare providers that enroll in the MSSP earn bonus payments for reducing spending to below a risk-adjusted financial benchmark that depends on the provider's historical spending. To generate savings, a provider must invest to improve efficiency, which is a cost that is absorbed entirely by the provider under the current contract. This has proven to be challenging for the MSSP, with a majority of participating providers unable to generate savings due to the associated costs. In this paper, we propose a predictive analytics approach to redesigning the MSSP contract with the goal of better aligning incentives and improving financial outcomes from the MSSP. We formulate the MSSP as a principal-agent model and propose an alternate contract that includes a performance-based subsidy to partially reimburse the provider's investment. We prove the existence of a subsidy-based contract that dominates the current MSSP contract by producing a strictly higher expected payoff for both Medicare and the provider. We then propose an estimator based on inverse optimization for estimating the parameters of our model. We use a dataset containing the financial performance of providers enrolled in the MSSP, which together accounts for 7 million beneficiaries and over $70 billion in Medicare spending. We estimate that introducing performance-based subsidies to the MSSP can boost Medicare savings by up to 40% without compromising provider participation in the MSSP. We also find that the subsidy-based contract performs well in comparison to a fully flexible, non-parametric contract.


Issues in Designing a Prescription Drug Benefit for Medicare

Issues in Designing a Prescription Drug Benefit for Medicare

Author:

Publisher:

Published: 2002

Total Pages: 76

ISBN-13:

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Book Synopsis Issues in Designing a Prescription Drug Benefit for Medicare by :

Download or read book Issues in Designing a Prescription Drug Benefit for Medicare written by and published by . This book was released on 2002 with total page 76 pages. Available in PDF, EPUB and Kindle. Book excerpt:


Redesigning Medicare

Redesigning Medicare

Author: Lynn Etheredge

Publisher:

Published: 1987

Total Pages: 73

ISBN-13:

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Book Synopsis Redesigning Medicare by : Lynn Etheredge

Download or read book Redesigning Medicare written by Lynn Etheredge and published by . This book was released on 1987 with total page 73 pages. Available in PDF, EPUB and Kindle. Book excerpt:


ADP Modernization

ADP Modernization

Author: United States. General Accounting Office

Publisher:

Published: 1989

Total Pages: 20

ISBN-13:

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Book Synopsis ADP Modernization by : United States. General Accounting Office

Download or read book ADP Modernization written by United States. General Accounting Office and published by . This book was released on 1989 with total page 20 pages. Available in PDF, EPUB and Kindle. Book excerpt:


Redesigning the Medicare Program

Redesigning the Medicare Program

Author: Andrew Coburn

Publisher:

Published: 2000

Total Pages: 22

ISBN-13:

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Book Synopsis Redesigning the Medicare Program by : Andrew Coburn

Download or read book Redesigning the Medicare Program written by Andrew Coburn and published by . This book was released on 2000 with total page 22 pages. Available in PDF, EPUB and Kindle. Book excerpt:


Get What's Yours for Medicare

Get What's Yours for Medicare

Author: Philip Moeller

Publisher: Simon and Schuster

Published: 2016-10-04

Total Pages: 304

ISBN-13: 1501124013

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A coauthor of the New York Times bestselling guide to Social Security Get What’s Yours authors an essential companion to explain Medicare, the nation’s other major benefit for older Americans. Learn how to maximize your health coverage and save money. Social Security provides the bulk of most retirees’ income and Medicare guarantees them affordable health insurance. But few people know what Medicare covers and what it doesn’t, what it costs, and when to sign up. Nor do they understand which parts of Medicare are provided by the government and how these work with private insurance plans—Medicare Advantage, drug insurance, and Medicare supplement insurance. Do you understand Medicare’s parts A, B, C, D? Which Part D drug plan is right and how do you decide? Which is better, Medigap or Medicare Advantage? What do you do if Medicare denies payment for a procedure that your doctor says you need? How do you navigate the appeals process for denied claims? If you’re still working or have a retiree health plan, how do those benefits work with Medicare? Do you know about the annual enrollment period for Medicare, or about lifetime penalties for late enrollment, or any number of other key Medicare rules? Health costs are the biggest unknown expense for older Americans, who are turning sixty-five at the rate of 10,000 a day. Understanding and navigating Medicare is the best way to save health care dollars and use them wisely. In Get What’s Yours for Medicare, retirement expert Philip Moeller explains how to understand all these important choices and make the right decisions for your health and wealth now—and for the future.


Book Synopsis Get What's Yours for Medicare by : Philip Moeller

Download or read book Get What's Yours for Medicare written by Philip Moeller and published by Simon and Schuster. This book was released on 2016-10-04 with total page 304 pages. Available in PDF, EPUB and Kindle. Book excerpt: A coauthor of the New York Times bestselling guide to Social Security Get What’s Yours authors an essential companion to explain Medicare, the nation’s other major benefit for older Americans. Learn how to maximize your health coverage and save money. Social Security provides the bulk of most retirees’ income and Medicare guarantees them affordable health insurance. But few people know what Medicare covers and what it doesn’t, what it costs, and when to sign up. Nor do they understand which parts of Medicare are provided by the government and how these work with private insurance plans—Medicare Advantage, drug insurance, and Medicare supplement insurance. Do you understand Medicare’s parts A, B, C, D? Which Part D drug plan is right and how do you decide? Which is better, Medigap or Medicare Advantage? What do you do if Medicare denies payment for a procedure that your doctor says you need? How do you navigate the appeals process for denied claims? If you’re still working or have a retiree health plan, how do those benefits work with Medicare? Do you know about the annual enrollment period for Medicare, or about lifetime penalties for late enrollment, or any number of other key Medicare rules? Health costs are the biggest unknown expense for older Americans, who are turning sixty-five at the rate of 10,000 a day. Understanding and navigating Medicare is the best way to save health care dollars and use them wisely. In Get What’s Yours for Medicare, retirement expert Philip Moeller explains how to understand all these important choices and make the right decisions for your health and wealth now—and for the future.