Medicare

The AJMC® Medicare compendium is a comprehensive resource for clinical news and expert insights on issues that affect Medicare beneficiaries with a focus on polypharmacy, reimbursement challenges, and other topics related to seniors.

Latest News

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Health Outcomes Under Full-Risk Medicare Advantage vs Traditional Medicare

May 9th 2025

Physician groups under 2-sided risk–based Medicare Advantage provide care associated with higher quality and efficiency compared with care by these same groups under fee-for-service Medicare.

AJMC
Evaluating Access to Care for Medicare Beneficiaries Younger Than 65 Years

May 7th 2025

glp-1 Wegovy, semaglutide | Image credit: Patrick Bay Damsted - stock.adobe.com
Can Medicare Sustain Widespread Access to GLP-1 Therapies?

April 25th 2025

AJMC
Impact of Hospital-Physician Integration on Medicare Patient Mix

April 11th 2025

CMS. | Image Credit: Postmodern Studio - stock.adobe.com
Survey Finds Slow Start on CMS Interoperability Rule Implementation

April 10th 2025

Examining the Benefit of an Innovative Enhanced Medication Therapy Management Model

In this series of articles, the authors present the MedWise Risk Score, an enhanced medication therapy management model, and its impact on medication safety reviews and health care outcomes.

AJMC Supplement Cover for Examining the Benefit of an Innovative Enhanced Medication Therapy Management Model

More News

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July 12th 2022

Medicare Advantage Coverage Restrictions for the Costliest Physician-Administered Drugs

Kelly E. Anderson, PhD, MPP G. Caleb Alexander, MD, MS Carolyne Ma, PharmD Sydney M. Dy, MD Aditi P. Sen, PhD, MA
Four large Medicare Advantage insurers manage access to expensive physician-administered drugs with a combination of prior authorization, step therapy, and Part D formulary design.
Robert Pittman, SVP, Government Affairs, Modivcare
July 10th 2022

Contributor: Technology, Supplemental Services in MA Can Help Improve Participant Health

Robert Pittman
Social determinants of health present many health-related challenges for Medicare Advantage (MA) plan members, something these plans are looking to overcome by diversifying their service offerings.
assortment of colorful pills
July 4th 2022

Treatment Simplification and Personalized Interventions May Reduce Medication Nonadherence

Lindsey Mulrooney
Simplified treatments and patient-specific and systemic interventions can reduce nonadherence in patients.
CMS Announces OCM Successor, but Gap Year Remains for Oncology Practices
June 27th 2022

CMS Announces OCM Successor, but Gap Year Remains for Oncology Practices

Mary Caffrey
Today, CMS unveiled its plan for a successor to the Oncology Care Model (OCM), its ambitious foray into value-based care delivery that has been credited with changing the landscape for patients with cancer, even if it received mixed reviews on achieving savings in its early years.
Thyme Care: A Human Touch in Cancer Care, Guided by Technology
June 23rd 2022

Thyme Care: A Human Touch in Cancer Care, Guided by Technology

Mary Caffrey
Oncologist and health tech veteran Bobby Green, MD, who practiced for 17 years in Florida and was previously with Flatiron, is now Thyme Care’s president and chief medical officer. He has relocated to Nashville, Tennessee, to launch Thyme Care.
diversity.
June 23rd 2022

Panel Addresses Data, Investment, and Engagement Strategies to Close the Health Equity Gap

Matthew Gavidia
Community engagement, investment, and quality metrics were spotlighted as potential solutions to address health inequities affecting marginalized communities nationwide.
washington dc picture
June 20th 2022

Medicare Hampered by Inaccurate Race, Ethnicity Data, OIG Says

Lindsey Mulrooney
A new report from the Office of Inspector General (OIG) of HHS suggests the accuracy of Medicare’s race and ethnicity data will only diminish over time, unless changes are implemented.
Supreme court
June 15th 2022

Supreme Court Unanimously Rules in Favor of Hospitals in 340B Decision

Laura Joszt, MA
The Supreme Court has ruled that HHS' decision to lower reimbursement rates to hospitals so that those in the 340B program received reduced rates because they received discounted drugs was unlawful.
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June 14th 2022

Financial Incentives Tied to Medicare Star Ratings: Impact on Influenza Vaccination Uptake in Medicare Beneficiaries

Bruce Stuart, PhD F. Ellen Loh, PhD Sachin Kamal-Bahl, PhD Jeffrey Vietri, PhD Daniel Bakken, MBA Justin Puckett, BA Jalpa A. Doshi, PhD
Influenza vaccine uptake improved among Medicare Advantage enrollees when influenza vaccination was introduced as a performance metric in Medicare star ratings and accompanying bonus payments.
Medicare beneficiaries
June 9th 2022

Health Care Access, Preventive Care Similar in MA and TM for Low-Income Adults

Lindsey Mulrooney
The analysis of adults with low income enrolled in Medicare Advantage (MA) or traditional Medicare (TM) indicates that increasing enrollment in MA may not advance health equity in the Medicare program.
The American Journal of Accountable Care
June 9th 2022

ACO REACH Brings Next Era of Medicare Payment Models

David Pittman, BS Clif Gaus, ScD
The Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model provides the next great opportunity in moving a health care payment system toward paying for value and rewarding preventive care and keeping patients healthy.
older woman
June 3rd 2022

Intervention May Improve Medication Appropriateness in Those With Multimorbidity, Polypharmacy

Gianna Melillo
Investigators in Spain tested whether the tool would work in elderly patients in the primary care setting.
pills
May 31st 2022

Review: Polypharmacy Significantly Linked With Malnutrition in Older Adults

Gianna Melillo
It is still unknown whether the relationship between polypharmacy and malnutrition is bidirectional and authors could not determine causation.
Jenny Schneider, MD
May 22nd 2022

Contributor: Value-Based Care Will Provide the Freedom to Fix What's Broken in Rural Health

Jenny Schneider, MD
The tools we need to achieve long-term stability for community providers and ensure better outcomes for rural Americans are available, and CMS can help us utilize them.
pills and syringe
May 20th 2022

Analysis Underscores Risks of Polypharmacy in Elderly Patients With Cancer

Gianna Melillo
Results of a secondary analysis of a randomized controlled trial emphasize the risks of polypharmacy with regard to prescription and nonprescription medications.
men in hospital
May 17th 2022

RAND Report Assesses Hospital Prices Paid by Employers, Private Insurers

Gianna Melillo
The report details totals paid to hospitals by private insurers and providers and compares the sums with a Medicare benchmark.
newspapers
May 13th 2022

What We’re Reading: Biden Addresses Baby Formula Shortage; Veterans’ Care Home Settlement; Hospital Stay Harms

AJMC Staff
President Joe Biden announces plans to improve baby formula shortages; Massachusetts reaches settlement with veterans who contracted COVID-19 in long-term care facility; a quarter of Medicare beneficiaries were harmed from hospital stays in 2018.
graphic of older female patient
May 8th 2022

Integrating Analytics With High-Touch Pharmacy Care for Vulnerable Beneficiaries

Allison Inserro
UPMC Health Plan, RxAnte, and Mosaic Pharmacy Services outlined how they are operating a value-based pharmacy care management program within Community HealthChoices, Pennsylvania’s managed Medicaid long-term services and supports (LTSS) program, at a recent conference.
US health care
May 5th 2022

Biden Administration May Make a Push for Health Care Priorities Ahead of Midterms

Laura Joszt, MA
Coverage, equity, and value-based payments are critical areas of focus for the Biden administration’s health care agenda leading up to the midterm elections, according to 3 experts from Avalere.
stethoscope, money and American Flag
April 29th 2022

Experts Discuss Driving Health Equity, Increasing CMS, ACO Alignment

Gianna Melillo
The opening plenary of the Spring 2022 National Association of Accountable Care Organizations conference focused on addressing health equity and improving synergy between CMS and ACOs.
WWR banner
April 28th 2022

What We’re Reading: Medicare Advantage Denies Care; US in Pandemic Transition Phase; Measles Cases Rise

AJMC Staff
Investigators have found that Medicare Advantage plans were denying care that should be covered for tens of thousands of people; Anthony Fauci, MD, claimed that the United States is in the transition phase of the pandemic; measles cases rose by 79% in 2022.
Alexis Garcia, PharmD
April 27th 2022

Dr Alexis Garcia on the Role of CYP450 Enzymes in Drug Efficacy

Allison Inserro Gianna Melillo
Alexis Garcia, PharmD, senior director of business development at Tabula Rasa HealthCare, outlines how cytochrome P450 enzymes can impact medication efficacy in patients taking multiple drugs.
Terry Wilcox.
April 17th 2022

Contributor: Reform Medicare’s Payment Policy to Expand Patient Access to Nonopioids

Terry Wilcox
Addressing the opioid crisis will require a strong, multifaceted approach that includes efforts to prevent addiction before it begins. By passing the NOPAIN Act, Congress can seize the win-win opportunity to reduce unnecessary exposure to opioids, while protecting—and expanding—a patient’s right to choose their own care.
Conference Coverage: ACCC 2022 AMCCBS
April 14th 2022

Conference Coverage: ACCC 2022 AMCCBS

Mary Caffrey
Coverage from the Association of Community Cancer Centers 2022 Annual Meeting and Cancer Center Business Summit, held in Washington, DC, March 2-4.
Screenshot of Steve Evans, MD, chief medical officer of SilverSummit at Centene
April 13th 2022

Dr Steve Evans on the Differences in Providing Care in Medicaid vs Medicare

Laura Joszt, MA
In Medicaid, delivering care needs to address the lack of resources and other socioeconomic factors that impact patients, said Steve Evans, MD, chief medical officer of SilverSummit at Centene.
pills
April 12th 2022

Assessing Polypharmacy in Nursing Home Residents in Spain

Gianna Melillo
Researchers investigated polypharmacy incidence in one of the fastest-aging regions in Spain.
Stephen Schleicher, MD, MBA
April 10th 2022

Dr Stephen Schleicher on Future Advances in Value-Based Care

Hayden E. Klein
Stephen Schleicher, MD, MBA, chief medical officer of Tennessee Oncology, talks about lessons learned from the Oncology Care Model (OCM) and Medicare that are being used to innovate toward value-based care.
Serving Nontraditional Health Care Needs in Medicare Through VBID
April 8th 2022

Serving Nontraditional Health Care Needs in Medicare Through VBID

Allison Inserro
Panelists touted the ability to pay for items and repairs to keep Medicare beneficiaries healthier at home, avoiding potentially costly hospitalizations and complications.
Incremental Steps Helpful but Not Enough to End Underinsurance Issue, Panelists Say
April 7th 2022

Incremental Steps Helpful but Not Enough to End Underinsurance Issue, Panelists Say

Allison Inserro
Without addressing rising costs, the problem of underinsurance in health care coverage will remain, said panelists at the 2022 V-BID Summit, discussing some of the smaller steps that are being proposed or are already in place to try to ease the financial burden.
Increasing Health Equity to Reduce Disparities in Value-Based Care
April 7th 2022

Increasing Health Equity to Reduce Disparities in Value-Based Care

Allison Inserro
At the 2022 V-BID Summit, hosted by the Center for Value-Based Insurance Design at the University of Michigan, representatives of CMS and the Commonwealth Fund gave an update on the efforts to monitor, evaluate, and improve health equity in the United States.
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