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 Policy in Flux: Trump Administration Updates

May 20th 2025

HHS announces it is taking steps to implement President Trump’s Executive Order on prescription drug pricing. Keep up with the latest moves made in health policy under President Donald Trump's second administration. This timeline will be updated as orders and policy progress.

AJMC
Health Outcomes Under Full-Risk Medicare Advantage vs Traditional Medicare

May 9th 2025

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

May 7th 2025

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Can Medicare Sustain Widespread Access to GLP-1 Therapies?

April 25th 2025

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Impact of Hospital-Physician Integration on Medicare Patient Mix

April 11th 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

Screenshot of Michael E. Chernew, PhD, in a video interview
April 5th 2022

Dr Michael Chernew Discusses the Continuous Testing of ACO Models

Laura Joszt, MA
Many of the accountable care organization (ACO) models are being tested to find changes to make to the Medicare Shared Savings Program, but there is a general problem with short-lived models ending and being replaced by new ones, said Michael Chernew, PhD.
Jason Z. Rose, MHSA
April 5th 2022

Contributor: Medication Adherence Is Not a Zero-Sum Game

Jason Z. Rose, MHSA
Mitigating the high cost of prescription drugs is a win-win to address the complex, multipronged problem of getting patients to take their medications as advised.
pills and money
April 4th 2022

Study Outlines Rate of Specialty Drug Noninitiation in Medicare Part D Beneficiaries

Gianna Melillo
New research published in Health Affairs details the rates of specialty medication noninitiation among Medicare Part D beneficiaries.
Why White Bagging Is a Symptom of High Drug Costs, and What States Are Doing
April 3rd 2022

Why White Bagging Is a Symptom of High Drug Costs, and What States Are Doing

Mary Caffrey
Many oncologists oppose white bagging because they prefer to be able to adjust doses during a visit based on lab reports taken that day.
Jackson Williams, JD
April 1st 2022

Contributor: ACOs Are Pro-Consumer, but Must Address Lack of Beneficiary Awareness

Jackson Williams, JD
Conversations are ongoing between CMS and patient advocates on how accountable care organizations (ACOs) and similar programs can better interface with beneficiaries.
Screenshot of Michael E. Chernew, PhD, from a video interview
March 29th 2022

Dr Michael Chernew Outlines the Attention to Health Equity in ACO REACH

Laura Joszt, MA
The accountable care organizations (ACOs) participating in the new ACO REACH model will have a health equity benchmark adjustment and need to collect more data to help better understand the populations being cared for and serve those from underserved communities, said Michael Chernew, PhD.
Michael E. Chernew, PhD, screenshot from a video interview
March 22nd 2022

Dr Michael Chernew Addresses the Direct Contracting Model’s Change to ACO REACH

Laura Joszt, MA
The Global and Professional Direct Contracting model is going to be replaced with a new accountable care organization (ACO) model, which addresses some of the pushback there had been on the direct contracting model, said Michael Chernew, PhD.
stethoscope and money
March 17th 2022

Two-Sided Risk Models Linked With Reduced Acute Care Use in Medicare Advantage

Gianna Melillo
Medicare advantage beneficiaries who received care from providers in 2-sided risk payment models had lower rates of acute care use, according to new study findings.
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March 17th 2022

What We’re Reading: FFS Medicare Savings; ICU Triage Discrimination; Pfizer, Moderna Patent Lawsuits

AJMC Staff
Medicare Advantage plan members could save $12 billion if enrolled in fee-for-service (FFS) plans instead; Black patients were classified as low priority for intensive care unit (ICU) triage twice as often as other patients; Moderna and Pfizer face lawsuits over potential COVID-19 vaccine patent infringement.
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March 15th 2022

The Unintended Consequences of Medicare’s Wage Index Adjustment on Device-Intensive Hospital Procedures

Guy David, PhD Candace Gunnarsson, EdD Liisa Laine, PhD Michael Ryan, MS Seth Clancy, MPH Gunnar Gunnarsson, MS Kimberly Moore, MS William Irish, PhD
The authors found an association between Medicare’s wage index adjustment and the differential use of labor-intensive surgical procedures and medical device–intensive minimally invasive clinical procedures across the United States.
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March 11th 2022

Small Practice Participation and Performance in Medicare Accountable Care Organizations

Jason B. Gibbons, PhD Chiang-Hua Chang, PhD Mousumi Banerjee, PhD Jennifer Meddings, MD, MSc Edward C. Norton, PhD Lena Chen, MD, MS Julie P.W. Bynum, MD, MPH
Medicare beneficiaries attributed to small practices in accountable care organizations (ACOs) achieve greater savings than beneficiaries attributed to large practices in ACOs.
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March 9th 2022

Primary Care Redesign and Care Fragmentation Among Medicare Beneficiaries

Lori Timmins, PhD Carol Urato, MA Lisa M. Kern, MD, MPH Arkadipta Ghosh, PhD Eugene Rich, MD
This article examines the association between a large-scale primary care redesign—the Comprehensive Primary Care Plus Initiative—and ambulatory care patterns of Medicare beneficiaries with highly fragmented care.
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March 8th 2022

Polypharmacy Nearly Doubles Health Care Expenditures Among Older Patients With CVD

Gianna Melillo
Polypharmacy was associated with a nearly doubled increase in health care expenditures and a tripled increase in pharmacy expenditures among older patients with cardiovascular diseases (CVD).
Natalie Dickson, MD
March 6th 2022

Dr Natalie Dickson Discusses 340B Reform From Tennessee Oncology’s Perspective

Hayden E. Klein
Natalie Dickson, MD, president and chief strategy officer of Tennessee Oncology, discusses Tennessee Oncology's role in the discussion to reform 340B.
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March 3rd 2022

What We’re Reading: Medicare Late-Fee Warnings; Pfizer Sends COVID-19 Pills Globally; Judge Blocks Transgender Investigation

AJMC Staff
A bill to provide late-fee warnings to Medicare beneficiaries was introduced; Pfizer is expected to provide 10 million COVID-19 antiviral pills to low- and middle-income nations; a Texas judge halts an investigation into a 16-year-old girl receiving gender-affirming treatment.
pills on scale
February 27th 2022

Metric Aims to Decrease Polypharmacy in Older Adults

Gianna Melillo
A new metric may help improve polypharmacy rates in older adults through identification of low-value prescribing practices.
insurance coverage
February 24th 2022

End of Public Health Emergency Triggers End to Medicare, Medicaid Flexibilities

Laura Joszt, MA
During an AHIP webinar, Mark Hamelburg, senior vice president of federal programs at AHIP, explained the shifts coming to Medicare and Medicaid when the public health emergency finally ends.
CMS Redesigns Direct Contracting Into an Equity-Focused ACO Model
February 24th 2022

CMS Redesigns Direct Contracting Into an Equity-Focused ACO Model

Allison Inserro
The redesigned accountable care organization (ACO) model is called the Realizing Equity, Access, and Community Health model and is scheduled to begin in 2023.
Stephen Schleicher, MD, MBA
February 20th 2022

Dr Stephen Schleicher on Tennessee Oncology's Plans Post OCM

Hayden E. Klein
Stephen Schleicher, MD, MBA, chief medical officer of Tennessee Oncology, discusses the practice's plans to continue providing quality oncology care to its patients after the end of the Oncology Care Model (OCM).
What We're Reading
February 16th 2022

What We’re Reading: Woman Cured of HIV; COVID-19 Vaccination During Pregnancy; Fight to Continue Direct Contracting Model

AJMC Staff
A woman is now the third person in the world to be cured of HIV; CDC data suggest vaccinating women against COVID-19 during pregnancy may protect infants after birth; provider groups push to keep Direct Contracting payment model.
Karen Kobelski, MBA.
February 15th 2022

Contributor: 3 Ways Health Plans Can Ensure Risk Adjustment Compliance

Karen Kobelski, MBA
By making diligent compliance efforts a priority in the years ahead, health plans can shore up existing processes to achieve financial success and ensure risk adjustment as regulatory bodies take aim at organizational missteps.
What we're reading.
February 14th 2022

What We're Reading: COVID-19 Vaccine Expansion Halted; PBM Probe; High-Volume Antibiotic Prescribers

AJMC Staff
The FDA delays its decision on Pfizer/BioNTech’s COVID-19 vaccine in young children; the Federal Trade Commission (FTC) will vote on whether to investigate pharmacy benefit managers (PBMs); nearly half of high-volume antibiotic prescribers are located in Southern states.
Alternative Payment Models Can Stabilize and Improve Practice Radiation Reimbursement
February 14th 2022

Alternative Payment Models Can Stabilize and Improve Practice Radiation Reimbursement

Courtney Dean, MBA
How Value-based Care Is Changing Radiation Oncology for the Better
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February 14th 2022

From Our Partners: Schleicher, Dickson Take New Roles at Tennessee Oncology

Hayden E. Klein Mary Caffrey
The changes come as Tennessee Oncology must now plan for a gap between the Oncology Care Model and a future alternative payment model from CMS.
Natalie Dickson, MD
February 13th 2022

Dr Natalie Dickson Discusses Challenges for Tennessee Oncology, Community Oncology

Hayden E. Klein
Natalie Dickson, MD, president and chief strategy officer of Tennessee Oncology, discusses challenges for Tennessee Oncology and community oncology in general.
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February 7th 2022

Effects of an Out-of-Pocket Maximum in Medicare Part D

Sonal Parasrampuria, PhD, MPH Gerard F. Anderson, PhD
This study compares the impact of the 3 different out-of-pocket maximums proposed in Congress and by the Medicare Payment Advisory Commission.
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February 4th 2022

Association of Opioid Utilization Management With Prescribing and Overdose

Martin S. Andersen, PhD Vincent Lorenz, MA Anurag Pant, MA Jeremy W. Bray, PhD G. Caleb Alexander, MD, MS
Opioid utilization management in Medicare was associated with mixed effects on opioid prescribing, and prior authorization was associated with a decreased likelihood of subsequent overdose.
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February 4th 2022

Value-Based Care Through Postacute Home Health Under CMS PACT Regulations

Patrick Racsa, MS Teresa Rogstad, MPH Brent Stice, MBA Matthew Flagg, MBA Chase Dailey, MBA Yong Li, PhD Brittany Sallee, BS Karen Worley, PhD Anup Sharma, MD David Annand, MD
Among a patient population defined by CMS postacute care transfer regulations, home health vs no postacute care was associated with reduced 30-day readmissions and costs.
hand holding prescription bottle
February 3rd 2022

Behavioral Therapy Can Help Reduce Polypharmacy in Borderline Personality Disorder, Study Finds

Gianna Melillo
Results of a retrospective study conducted in Spain found that dialectical-behavioral therapy skills training can help mitigate polypharmacy in those with borderline personality disorder.
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February 3rd 2022

What We’re Reading: Boosters Slash COVID-19 Deaths; Generic Restasis Cleared; Medicare Advantage and Health Equity

AJMC Staff
Americans who are boosted are 95 times less likely than unvaccinated people to die of COVID-19, the FDA approved the first generic drug for Restasis to treat dry eye syndrome, and CMS is putting a greater focus on health equity for Medicare Advantage and Part D plans.
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