The Medicare Participating Physician Program was enacted in 1984 in an effort to increase physician assignment of Medicare claims, and thereby reduce beneficiary out of-pocket expenses. The program offers the physician the security of near-certain payment on all claims, although at rates that are in many cases, at levels substantially, less than actual physician fees. This paper examines the economic factors that influence the physician's decision on participation. Physicians of the Medical Society of Prince William County, Virginia, were surveyed for information relevant to making the participation decision and the responses tabulated and used as input to a regression equation estimated using the logit technique. Physicians are more likely to participate the higher the relative price received for participating and the lower the probability of payment by Medicare-eligible patients. Additionally, salaried physicians are more likely to partiCipate than those who are self-employed. / Master of Arts

Thesis (Ph. D.)--RAND Graduate School, 2002. / Includes bibliographical references (p. 96-101).

Thesis (Ph. D.)--University of Alabama at Birmingham, 2007. / Title from PDF title page (viewed Sept. 21, 2009). Additional advisors: Richard M. Allman, Karlene K. Ball, Monika M. Safford, David E. Vance. Includes bibliographical references (p. 62-72).

Thesis (Ph.D.)--RAND Graduate School, 2002. / Includes bibliographical references (p. 96-101).

Thesis (Ph.D.)--RAND Graduate School, 2005. / Includes bibliographical references.

<p>  </p> <p><strong>OBJECTIVES:</strong> Medication synchronization (med-sync) aligns patients’ chronic medications to a predetermined routine pickup date at a community pharmacy. An appointment-based model (ABM) med-sync service includes a comprehensive medication review at the pharmacy. We had the following objectives: (1) To systematically characterize literature describing healthcare utilization, cost clinical, and humanistic outcomes for patients enrolled in medication synchronization, (2) to determine the characteristics of Medicare Part D beneficiaries’ receipt of medication synchronization program and (3) to compare healthcare utilization outcomes of Medicare beneficiaries enrolled in an ABM med-sync program to beneficiaries not enrolled in such a program.</p> <p><br></p> <p><strong>METHODS:</strong> A systematic literature review was conducted using electronic databases from January 2008 to October 2022. The retrospective cohort study analyzed Medicare claims data from 2014-16 for a sample of 1 million beneficiaries utilizing community pharmacies identified as offering a med-sync program. Medicare inpatient, outpatient, emergency, and pharmacy claims data were used to create med-sync and non-med-sync cohorts. We applied Andersen’s Health Services Utilization model to determine factors associated with med-sync enrollment. We constructed logistic regression models with med-sync enrollment as the dependent variable adding predisposing, enabling, and need variables. Descriptive statistics and bi-variate analysis were performed on the cohorts. All patients were followed longitudinally for 12 months before and after a 2015 index/enrollment month to calculate healthcare utilization. Difference-in-differences (DID) was used to compare mean changes in utilization outcomes between cohorts before and after enrollment.</p> <p><br></p> <p><strong>RESULTS:</strong> Through systematic review, we found limited studies related to costs and healthcare utilization. Med-sync programs have shown to increase drug adherence to medications and improve patient satisfaction. For our study with Medicare beneficiaries, we identified 13,193 beneficiaries in the med-sync cohort and 156,987 beneficiaries in non-med sync (control) cohort. As age of beneficiaries increased, likelihood of med-sync enrollment increased (AOR=1.003, 95% CI:1.001-1.005). There were ​higher odds of enrollment for beneficiaries residing in Northeast (AOR=1.094, 95% CI:1.018-1.175), South (AOR=1.109, 95% CI:1.035-1.188), and West (AOR=1.113, 95% CI:1.020-1.215) than the Midwest. Beneficiaries residing in non-metro areas had lower odds of enrollment​ (AOR: 0.914, 95% CI: 0.863-0.969) than metro areas. Beneficiaries with less previous inpatient hospitalizations (AOR=0.945, 95% CI:0.914-0.977) were less likely to be enrolled whereas those with higher outpatient visits (AOR=1.003, 95% CI:1.001-1.004) were more likely to be enrolled. Beneficiaries taking a higher number of oral chronic medications (AOR=1.005, 95% CI:1.002-1.008) had greater odds of enrollment in med-sync. After propensity matching, 13,193 beneficiaries in each cohort were used for analysis. Mean pharmacy utilizations increased before and after enrollment for both cohorts while mean outpatient utilization decreased before and after enrollment for med-sync cohort only. Healthcare utilization mean DID were significantly less in the med-sync cohort compared to the non-med-sync cohort for outpatient visits (DID: 0.01, p=0.0073) and pharmacy fills (DID: 0.01, p<0.0001). There was no significant DID for inpatient and emergency visits between cohorts.</p> <p><br></p> <p><strong>CONCLUSION:</strong> Disparities in age, geographic region, type of residence and prior health utilization for med-sync enrollment were identified. Outpatient and pharmacy utilization changes were significantly lower in med-sync cohort compared to the non-med-sync cohort in the 12-months after enrollment. Lower pharmacy utilization could be due to optimization of therapy during medication reviews of ABM med-sync. As Medicare is approaching to a value-based system, there needs to be a greater focus on systems such as med-sync that has shown to improve a patient’s adherence. </p>

This dissertation examined the impact of Medicare Plan D on medication compliance in Medicare beneficiaries at University of Texas Health Center at Tyler, TX. Data were collected before and after the implementation of Plan D. The impacts of various types of benefits, such as private insurance, employer insurance and pharmacy assistance programs were evaluated in terms of impact on drug compliance. Medication compliance was found to increase in those respondents without Plan D. Plan D was found to be a predictor of those who spent less on basics in order to buy medications. Although compliance increased in general, these increases could not be attributed to the acquisition of a Plan D policy.

No description available.

Since its inception in 2003, Medicare Part D has become the largest addition to the Medicare benefit since it was signed into law in 1965. Despite this novel prescription drug coverage, the design and benefit structure of Medicare Part D has been challenging for beneficiaries and healthcare providers alike. Beneficiaries have been faced with a plethora of drug plan offerings. Additionally, the unique benefit structure and annual variation in plan offerings and plan parameters have left beneficiaries unaware of gaps in coverage and reluctant to re-evaluate plan offerings. Despite these issues, to date the total out-of-pocket costs for beneficiaries enrolled in Medicare Part D have not been examined. To mitigate this void, three studies were conducted to determine trends in the total out-of-pocket costs incurred by Medicare beneficiaries enrolled in Medicare Part D prescription drug plans. Pharmacy claims data of 50 randomly sampled patients from a database of Medicare-eligible individuals were used to generate medication profiles. To maintain a patient-perspective approach, these profiles were then entered into the Plan Finder Tool on the Medicare website in order to determine the estimated annual costs for each stand-alone prescription drug plan in each Medicare region. It was determined that Medicare Part D plan costs increased from 2007 to 2008 in most regions, however in 13 of 34 regions patients may not have paid more if they were enrolled in the lowest cost plan each year. Based on these findings, the opportunity cost of neglecting to re-evaluate prescription drug plan offerings for 2008 was examined. A significant increase ranging from $277 to $562 was observed nationally if patients did not switch to the lowest cost plan. Only 12% of the plans remained the lowest cost plan in 2008. Lastly, prescription drug plan cost trends in California were examined from 2007 to 2009 and confirmed that the estimated annual cost of a plan was the most consistent plan parameter. Collectively these studies indicate that Medicare Part D beneficiaries must annually re-evaluate all prescription drug plan offerings in order to minimize out-of-pocket drug costs.

Managed care plans purport to improve the health of their members with chronic diseases. How has the growing adoption of Medicare Advantage (MA), the managed care program for Medicare beneficiaries, affected the progression of chronic disease? The literature is rich with articles focusing on managed care organizations' impacts on quality of care, access, patient satisfaction, and costs. However, few studies have analyzed these impacts with respect to market penetration of Medicare managed care. The objective of this research has been to analyze the relationships between the market penetration of MA plans and the progression of chronic diseases among Medicare beneficiaries. The Chronic Disease Severity Index scale (CDSI) was constructed to represent beneficiaries' overall chronic disease states for survey or claims-based data, when more direct clinical measures of disease progression are not available. Using the CDSI on the MEPS survey dataset from AHRQ, we sought to assess the impacts of MA market penetration and other covariates on the overall chronic disease state of Medicare beneficiaries from 2004 through 2008. Though the model explains much of the variation in CDSI change, the author expected the multilevel model would show that MA penetration explains a significant level of variation in CDSI change. However, this hypothesis was not substantiated, and the findings suggest that unmeasured factors may be contributing to additional unexplained heterogeneity. Policymakers should explore opportunities to refine the current MA program. The MA program costs the federal government more than the Traditional Fee-for-Service Medicare program, and there is no definitive evidence that outcomes differ. Within both programs, there is opportunity to experiment with different models of payment, healthcare service delivery and care coordination. The Patient Protection and Affordable Care Act (ACA) contains provisions for innovative demonstration projects in delivery and payment. The effectiveness of these ACA initiatives must be monitored, both for impacts on health outcomes and for economic effects. This research can inform future approaches to outcomes assessment using the CDSI, and multilevel modeling methodologies similar to those employed here. Firms offering MA health plans would be prudent to proactively demonstrate their value to beneficiaries and taxpayers. They should explore means of better monitoring and reporting the longitudinal outcomes of their enrolled beneficiaries. Demonstrating that they can bring value in terms of improved health outcomes will help insure their long-term survival, both in the marketplace and in the political arena. / Graduation date: 2012