National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
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- Access to Care (3)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 21 of 21 Research Studies DisplayedNeprash HT, Zink A, Sheridan B
The effect of Medicaid expansion on Medicaid participation, payer mix, and labor supply in primary care.
AHRQ-funded; HS024455.
Citation: Neprash HT, Zink A, Sheridan B .
The effect of Medicaid expansion on Medicaid participation, payer mix, and labor supply in primary care.
J Health Econ 2021 Dec;80:102541. doi: 10.1016/j.jhealeco.2021.102541..
Keywords: Medicare, Healthcare Utilization, Primary Care, Workforce, Health Insurance
Markovitz AA, Ayanian JZ, Sukul ED
The Medicare Advantage Quality Bonus Program has not improved plan quality.
The authors analyzed insurance claims from the period 2009-2018 from the nation's largest Medicare Advantage (MA) claims database. They evaluated changes in performance on nine claims-based measures of quality before and after the start of the bonus program and with adjustment for differential pre-period trends. They found that program participation was associated with significant quality improvements among MA beneficiaries on four measures, significant declines on four other measures, and no significant change in overall quality performance, suggesting that the quality bonus program did not produce the intended improvement in overall quality performance of MA plans.
AHRQ-funded; HS000053.
Citation: Markovitz AA, Ayanian JZ, Sukul ED .
The Medicare Advantage Quality Bonus Program has not improved plan quality.
Health Aff 2021 Dec;40(12):1918-25. doi: 10.1377/hlthaff.2021.00606..
Keywords: Medicare, Health Insurance
McInerney M, Mellor JM, Sabik LM. M, Mellor JM, Sabik LM
Welcome mats and on-ramps for older adults: the impact of the Affordable Care Act's Medicaid Expansions on Dual Enrollment in Medicare and Medicaid.
The authors examined whether Medicaid participation by low-income adults age 65 and up increased as a result of Medicaid expansions to working-age adults under the Affordable Care Act (ACA). Using American Community Survey data and state variation in ACA Medicaid expansions, they found that Medicaid expansions to working-age adults increased Medicaid participation among low-income older adults by 4.4 percent. They also found evidence of an “on-ramp” effect, which is an important mechanism behind welcome mat effects among some older adults.
AHRQ-funded; HS025422.
Citation: McInerney M, Mellor JM, Sabik LM. M, Mellor JM, Sabik LM .
Welcome mats and on-ramps for older adults: the impact of the Affordable Care Act's Medicaid Expansions on Dual Enrollment in Medicare and Medicaid.
J Policy Anal Manage 2021 Win;40(1):12-41. doi: 10.1002/pam.22259..
Keywords: Elderly, Medicaid, Medicare, Low-Income, Health Insurance, Policy
Markovitz AA, Ayanian JZ, Warrier A
Medicare Advantage plan double bonuses drive racial disparity in payments, yield no quality or enrollment improvements.
Using national data for 2008-18, investigators found that double bonuses were not associated with either improvements in plan quality or increased Medicare Advantage enrollment. Additionally, double bonuses increased payments to plans to care for Black beneficiaries by $60 per year, compared with $91 for White beneficiaries. These findings suggest that double bonuses not only fail to improve quality and enrollment but also foster a racially inequitable distribution of Medicare funds that disfavors Black beneficiaries. This study supports eliminating double bonuses, thereby saving Medicare an estimated $1.8 billion per year.
AHRQ-funded; HS000053.
Citation: Markovitz AA, Ayanian JZ, Warrier A .
Medicare Advantage plan double bonuses drive racial disparity in payments, yield no quality or enrollment improvements.
Health Aff 2021 Sep;40(9):1411-19. doi: 10.1377/hlthaff.2021.00349..
Keywords: Medicare, Health Insurance, Payment, Quality Improvement, Quality of Care, Disparities, Racial and Ethnic Minorities
Roberts ET, Glynn A, Donohue JM
The relationship between take-up of prescription drug subsidies and Medicaid among low-income Medicare beneficiaries.
In this study, the investigators examined take-up of the Low-Income Subsidy (LIS) and Medicaid among Medicare beneficiaries who qualified for both programs. They went beyond prior analyses that reported average enrollment by program by 1.) examining whether LIS take-up mirrored Medicaid enrollment at income levels where individuals qualified for limited Medicaid benefits that had low take-up rates and 2.) highlighting opportunities for policy reforms to increase participation in both programs.
AHRQ-funded; HS026727.
Citation: Roberts ET, Glynn A, Donohue JM .
The relationship between take-up of prescription drug subsidies and Medicaid among low-income Medicare beneficiaries.
J Gen Intern Med 2021 Sep;36(9):2873-76. doi: 10.1007/s11606-020-06241-y..
Keywords: Medicaid, Medicare, Medication, Low-Income, Health Insurance
Moloci NM, Si Y, Norton EC
Predicting losses from Medicare Shared Savings Program departures.
Researchers conducted an observational study to understand how accountable care organization (ACO) exit could affect Shared Savings Program (SSP) financial performance. They found that nearly 80% of ACOs were still active at the end of 2016. Among the subset that faced contract renewal in 2019, 40% were known to have exited the SSP. By 2022, ACOs that exited in 2019 could cost the SSP $186.9 million in lost savings. If the exit rate observed in 2019 continues, the SSP could suffer $396.8 million in lost savings by 2022.
AHRQ-funded; HS024525; HS024728.
Citation: Moloci NM, Si Y, Norton EC .
Predicting losses from Medicare Shared Savings Program departures.
J Gen Intern Med 2021 Aug;36(8):2490-91. doi: 10.1007/s11606-020-06424-7..
Keywords: Medicare, Health Insurance, Healthcare Costs
Eisenberg MD, Meiselbach MK, Bai G
Large self-insured employers lack power to effectively negotiate hospital prices.
This study examined the ability of self-insured employers to negotiate hospital prices and investigated the relationship between hospital prices and employer market power in the United States. Findings showed that employer market power was low in most metropolitan statistical areas. Recommendations included encouraging self-insured employers to consider building purchase alliances with state and local government employee groups in order to enhance their market power and to lower negotiated prices for hospital services.
AHRQ-funded; HS000029.
Citation: Eisenberg MD, Meiselbach MK, Bai G .
Large self-insured employers lack power to effectively negotiate hospital prices.
Am J Manag Care 2021 Jul;27(7):290-96. doi: 10.37765/ajmc.2021.88702..
Keywords: Health Insurance, Medicare, Medicaid, Healthcare Costs, Hospitals
Roberts ET, Desai SM
Does Medicaid coverage of Medicare cost sharing affect physician care for dual-eligible Medicare beneficiaries?
The objective of this paper was to assess changes in physicians' provision of care to duals (low-income individuals with Medicare and Medicaid) in response to a policy that required Medicaid to fully pay Medicare's cost sharing for office visits with these patients. This policy-a provision of the Affordable Care Act-effectively increased payments for office visits with duals by 0%-20%, depending on the state, in 2013 and 2014.
AHRQ-funded; HS026727; HS026980.
Citation: Roberts ET, Desai SM .
Does Medicaid coverage of Medicare cost sharing affect physician care for dual-eligible Medicare beneficiaries?
Health Serv Res 2021 Jun;56(3):528-39. doi: 10.1111/1475-6773.13650..
Keywords: Medicare, Medicaid, Health Insurance, Access to Care, Healthcare Costs, Low-Income
Roberts ET, James AE, Sabik LM
Modernizing Medicaid coverage for Medicare beneficiaries with low income.
Medicaid serves as a supplemental insurer for eleven million low-income Medicare beneficiaries, known as duals. For these beneficiaries, Medicaid pays for Medicare’s out-of-pocket costs, including premiums, deductibles and coinsurance. This paper examined opportunities to close these gaps in Medicaid coverage and discussed how these reforms could complement other efforts to modernize Medicaid for low-income Medicare beneficiaries.
AHRQ-funded; HS026727.
Citation: Roberts ET, James AE, Sabik LM .
Modernizing Medicaid coverage for Medicare beneficiaries with low income.
JAMA Health Forum 2021 Jun;2(6). doi: 10.1001/jamahealthforum.2021.0989..
Keywords: Medicaid, Medicare, Low-Income, Health Insurance, Policy
Fung V, McCarthy S, Price M
Payment discrepancies and access to primary care physicians for dual-eligible Medicare-Medicaid beneficiaries.
This study examined whether the Affordable Care Act (ACA) primary care fee bump for dual-eligible Medicare-Medicaid beneficiaries impacted primary care physicians (PCP) acceptance of duals. The authors assessed differences in the likelihood that PCPs had dual caseloads of ≥10% or 20% in states with lower versus full dual reimbursement using linear probability models adjusted for physician and area-level traits. The proportion of PCPs with dual caseloads of ≥10% or 20% decreased significantly between 2012 and 2017. The fee bump was not consistently associated with increases in dual caseloads.
AHRQ-funded; HS024725.
Citation: Fung V, McCarthy S, Price M .
Payment discrepancies and access to primary care physicians for dual-eligible Medicare-Medicaid beneficiaries.
Med Care 2021 Jun;59(6):487-94. doi: 10.1097/mlr.0000000000001525..
Keywords: Primary Care, Medicaid, Medicare, Health Insurance, Payment, Access to Care
Lyu PF, Chernew ME, McWilliams JM
Soft consolidation In Medicare ACOs: potential for higher prices without mergers or acquisitions.
Using commercial claims and data on health system membership and Medicare accountable care organizations (ACOs) participation, investigators found some abrupt, large price increases for independent primary care practices that joined health system-led ACOs but were not acquired by systems. These price jumps were rare, however, increasing prices by just 4 percent, on average, among all independent practices in system-led ACOs. The price jumps were more consistent with an extension of existing pricing power from systems to some independent practices than with a major expansion of system market power.
AHRQ-funded; HS024072; HS027531.
Citation: Lyu PF, Chernew ME, McWilliams JM .
Soft consolidation In Medicare ACOs: potential for higher prices without mergers or acquisitions.
Health Aff 2021 Jun;40(6):979-88. doi: 10.1377/hlthaff.2020.02449..
Keywords: Medicare, Health Insurance, Healthcare Costs
Roberts ET, Glynn A, Cornelio N
Medicaid coverage 'cliff' increases expenses and decreases care for near-poor Medicare beneficiaries.
Cost sharing in traditional Medicare can consume a substantial portion of the income of beneficiaries who do not have supplemental insurance, resulting in a supplemental coverage cliff. The authors estimated that Medicaid beneficiaries affected by this cliff incurred an additional $2,288 in out-of-pocket spending over the course of two years, used 55 percent fewer outpatient evaluation and management services per year, and filled fewer prescriptions. They recommended expanding eligibility for Medicaid supplemental coverage and increasing take-up of Part D subsidies to lessen cost-related barriers to health care among near-poor Medicare beneficiaries.
AHRQ-funded; HS026727.
Citation: Roberts ET, Glynn A, Cornelio N .
Medicaid coverage 'cliff' increases expenses and decreases care for near-poor Medicare beneficiaries.
Health Aff 2021 Apr;40(4):552-61. doi: 10.1377/hlthaff.2020.02272..
Keywords: Medicaid, Medicare, Healthcare Costs, Low-Income, Health Insurance
Jacobs PD, Kronick R
AHRQ Author: Jacobs PD
The effects of coding intensity in Medicare Advantage on plan benefits and finances.
The authors assessed how beneficiary premiums, expected out-of-pocket costs, and plan finances in the Medicare Advantage (MA) market are related to coding intensity. The study sample included beneficiaries enrolled in both MA and Part D from 2008-2015; Medicare claims and drug utilization data for Traditional Medicare beneficiaries were used to calibrate an independent measure of health risk. The authors found that, while coding intensity increased taxpayers' costs of the MA program, enrollees and plans both benefitted but with larger gains for plans. They concluded that the adoption of policies to adjust more completely for coding intensity would likely affect both beneficiaries and plan profits.
AHRQ-authored.
Citation: Jacobs PD, Kronick R .
The effects of coding intensity in Medicare Advantage on plan benefits and finances.
Health Serv Res 2021 Apr;56(2):178-87. doi: 10.1111/1475-6773.13591..
Keywords: Medicare, Health Insurance, Healthcare Costs, Policy
Chen G, Lewis VA, Gottlieb D
Estimating heterogeneous effects of a policy intervention across organizations when organization affiliation is missing for the control group: application to the evaluation of accountable care organizations.
This study looked at the effects of accountable care organizations (ACOs) on lowering health care costs and reducing the rate of hospital readmissions. The authors used Medicare fee-for-service claims data from 2009-2014 to estimate the heterogenous effects of Medicare ACO programs on hospital admissions across hospital referral regions and provider groups. The results suggested that the ACO programs reduced the rate of readmission to hospitals, and that the effect of joining an ACO varied considerably across medical groups.
AHRQ-funded; HS024075.
Citation: Chen G, Lewis VA, Gottlieb D .
Estimating heterogeneous effects of a policy intervention across organizations when organization affiliation is missing for the control group: application to the evaluation of accountable care organizations.
Health Serv Outcomes Res Methodol 2021 Mar;21(1):54-68. doi: 10.1007/s10742-020-00230-8..
Keywords: Medicare, Policy, Healthcare Costs, Hospital Readmissions, Health Insurance
McCoy RG, Van Houten HK, Deng Y
Comparison of diabetes medications used by adults with commercial insurance vs Medicare Advantage, 2016 to 2019.
Investigators sought to compare trends in initiation of treatment with GLP-1RA, SGLT2i, and DPP-4i by older adults with type 2 diabetes insured by Medicare Advantage vs commercial health plans. They found that Medicare Advantage beneficiaries may be less likely than commercially insured beneficiaries to be treated with newer medications to lower glucose levels, with greater disparities among lower-income patients. They recommended further investigation of nonclinical factors contributing to treatment decisions and efforts to promote greater equity in diabetes management.
AHRQ-funded; HS025164.
Citation: McCoy RG, Van Houten HK, Deng Y .
Comparison of diabetes medications used by adults with commercial insurance vs Medicare Advantage, 2016 to 2019.
JAMA Netw Open 2021 Feb;4(2):e2035792. doi: 10.1001/jamanetworkopen.2020.35792..
Keywords: Elderly, Diabetes, Chronic Conditions, Medication, Medicare, Health Insurance, Disparities, Low-Income
Fung V, Price M, Hull P
Assessment of the Patient Protection and Affordable Care Act's increase in fees for primary care and access to care for dual-eligible beneficiaries.
The purpose of this study was to examine the association between the Affordable Care Act (ACA) fee bump and primary care visits for dual-eligible Medicare and Medicaid beneficiaries. Medicare claims data from 2012 to 2016 was used. Findings showed that the ACA fee bump was not associated with increases in primary care visits for dual-eligible Medicare and Medicaid beneficiaries. Additionally, visits for dual-eligible beneficiaries with primary care physicians decreased after the ACA, a decrease that was partially offset by increases in visits with nonphysician clinicians.
AHRQ-funded; HS024725; HS025378.
Citation: Fung V, Price M, Hull P .
Assessment of the Patient Protection and Affordable Care Act's increase in fees for primary care and access to care for dual-eligible beneficiaries.
JAMA Netw Open 2021 Jan;4(1):e2033424. doi: 10.1001/jamanetworkopen.2020.33424..
Keywords: Access to Care, Medicaid, Medicare, Health Insurance, Healthcare Costs, Policy
Fraze TK, Beidler LB, Briggs ADM
Translating evidence into practice: ACOs' use of care plans for patients with complex health needs.
Researchers sought to understand how Medicare accountable care organizations (ACOs) use care plans to manage patients with complex clinical needs. After conducting semi-structured interviews with Medicare ACOs, they found that ACOs were using care plans for patients with complex needs, but their use of care plans did not always meet the best practices; ACOs were adapting use of care plans to better fit the needs of patients and providers.
AHRQ-funded; HS024075.
Citation: Fraze TK, Beidler LB, Briggs ADM .
Translating evidence into practice: ACOs' use of care plans for patients with complex health needs.
J Gen Intern Med 2021 Jan;36(1):147-53. doi: 10.1007/s11606-020-06122-4..
Keywords: Implementation, Evidence-Based Practice, Medicare, Health Insurance, Healthcare Delivery
Trish E, Joyce G, Goldman DP
Specialty drug spending trends among Medicare and Medicare Advantage enrollees, 2007-11.
The authors analyzed trends in specialty drug spending among Medicare beneficiaries ages sixty-five and older using 2007-11 pharmacy claims data. They found that annual specialty drug spending per beneficiary who used specialty drugs increased considerably during the study period, but specialty drugs accounted for less than ten percent of total drug spending per beneficiary. Additionally, in 2011, cost-sharing reductions under the Affordable Care Act significantly reduced specialty drug users' out-of-pocket burden, which decreased 26 percent from 2010.
AHRQ-funded; HS000046.
Citation: Trish E, Joyce G, Goldman DP .
Specialty drug spending trends among Medicare and Medicare Advantage enrollees, 2007-11.
Health Aff 2014 Nov;33(11):2018-24. doi: 10.1377/hlthaff.2014.0538.
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Keywords: Healthcare Costs, Health Insurance, Medicare, Medication
Yehia BR, Fleishman JA, Agwu AL
AHRQ Author: Fleishman JA
Health insurance coverage for persons in HIV care, 2006-2012.
The authors examined trends in health insurance coverage at 11 US HIV clinics between 2006 and 2012. They found that Medicaid coverage was more prevalent among women than men; blacks and Hispanics than whites; and individuals with injection drug use risk compared with other transmission risk factors, with Hispanics and younger age groups more likely to be uninsured than other racial/ethnic and older age groups, respectively.
AHRQ-authored; AHRQ-funded; 290201100007C.
Citation: Yehia BR, Fleishman JA, Agwu AL .
Health insurance coverage for persons in HIV care, 2006-2012.
J Acquir Immune Defic Syndr 2014 Sep 1;67(1):102-6. doi: 10.1097/qai.0000000000000251.
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Keywords: Health Insurance, Human Immunodeficiency Virus (HIV), Medicare, Racial and Ethnic Minorities, Uninsured
Kronick R, Welch WP
AHRQ Author: Kronick R
Measuring coding intensity in the Medicare Advantage program.
Each year from 2004-2013, the average Medicare Advantage risk score increased faster than the average fee-for-service score. The intensity of coding varies widely by contract. The authors suggested that with the continuous relative increase in the average Medicare Advantage risk score, further policy changes will likely be necessary.
AHRQ-authored.
Citation: Kronick R, Welch WP .
Measuring coding intensity in the Medicare Advantage program.
Medicare Medicaid Res Rev 2014 Jul 17;4(2). doi: 10.5600/mmrr2014-004-02-a06.
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Keywords: Medicare, Health Insurance, Payment
Erten MZ, Davidoff AJ, Zuckerman IH
AHRQ Author: Davidoff AJ
The effect of supplemental medical and prescription drug coverage on health care spending for Medicare beneficiaries with cancer.
The researchers examined whether patients with newly diagnosed cancer respond differently to supplemental coverage than the general Medicare population. They concluded that Medicare beneficiaries with cancer are less responsive to the presence and type of supplemental insurance than are beneficiaries without cancer. They recommended that policymakers consider welfare effects associated with coverage restrictions.
AHRQ-authored.
Citation: Erten MZ, Davidoff AJ, Zuckerman IH .
The effect of supplemental medical and prescription drug coverage on health care spending for Medicare beneficiaries with cancer.
Value Health 2014 Jan-Feb;17(1):15-21. doi: 10.1016/j.jval.2013.11.003.
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Keywords: Cancer, Health Insurance, Medicare, Medication