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

Group of older adults outside together | Image credit: Rawpixel.com – stock.adobe.com
5 Evidence-Based Practices to Help Older Adults Live Independently

July 4th 2025

Falls can often lead to reduced mobility or long-term disability in adults 65 and older, but there are strategies beyond exercise that can help these patients stay independent longer.

Democratic Doctors Caucus June 11 Press Conference
Democratic Doctors Caucus Reaffirms EMTALA Amid Trump's CMS Policy Reversal on Abortion Care

June 18th 2025

The Choose Medicare Act would establish a Medicare “Part E” that would give employers and the general public the option to opt into the program. | Image credit: zimmytws - AdobeStock_45882892
Democrats Introduce Bill to Create Public Medicare “Part E”

June 17th 2025

Inflation Reduction Act | Image Credit: wladimir1804-stock.adobe.com
Community Oncology Bracing for IRA Impact

May 31st 2025

Veteran health. | Image Credit: Africa Studio - stock.adobe.com
Strategies to Address Veteran Health Disparities Beyond the Battlefield

May 30th 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

With Diversification Advisory Council, SCAN Group Plans for Growth in Care for Older Adults
November 17th 2021

With Diversification Advisory Council, SCAN Group Plans for Growth in Care for Older Adults

Mary Caffrey
To guide its growth and its forays into home-based care, SCAN Group recently announced a Diversification Advisory Council, a group of 6 leaders from inside and outside health care with expertise in health care technology, reimbursement, and consumer engagement.
What we're reading stock photo.
November 15th 2021

What We're Reading: Vaccine Mandate Hold Extended; Medicare Premiums Spike; Booster Eligibility Expands

AJMC Staff
Appeals court affirms decision to place a hold on the Biden administration's COVID-19 vaccine mandate for large employers; rising Medicare premiums linked with controversial Alzheimer drug; 3 states expand COVID-19 booster shot eligibility to all adults.
Jason Z. Rose, MHSA
November 15th 2021

Contributor: Medicare Advantage Plans Can’t Get Complacent About Artificially Inflated 2022 Star Ratings Results

Jason Z. Rose, MHSA
COVID-19 prompted CMS to make major adjustments to the Medicare Advantage (MA) Star Ratings System, resulting in better-than-average performance for nearly all plans. However, these changes were temporary, and MA plans will have to reset their strategies for 2023 and beyond.
Michael E. Chernew, PhD
November 11th 2021

A National Perspective of the Opportunities, Challenges Facing Health Care Cost and Sustainability

Matthew Gavidia
Michael E. Chernew, PhD, co-editor-in-chief of The American Journal of Managed Care®, discussed cost and sustainability issues specific to commercial insurance, Medicare, and Medicaid at the National Alliance 2021 Annual Forum held in a hybrid format in Washington, DC.
Anticholinergic Polypharmacy in Medicare Not Common but Still Problematic, Study Says
November 10th 2021

Anticholinergic Polypharmacy in Medicare Not Common but Still Problematic, Study Says

Allison Inserro
The share of patients meeting the definition of polypharmacy for the condition of overactive bladder declined from 2006 to 2017, but the phenomenon was still prevalent in women and patients in nursing homes, according to a recent study.
Potentially Inappropriate Medications, Drug Interactions Common in Geriatric Cancer
October 30th 2021

Potentially Inappropriate Medications, Drug Interactions Common in Geriatric Cancer

Rose McNulty
Multiple comorbidities and medications are prevalent in older cancer populations, who may benefit from structured medication reviews by specialist geriatricians.
Highest Cancer Care Cost Burden Happens at 2 Time Points in Medicare, Report Says
October 29th 2021

Highest Cancer Care Cost Burden Happens at 2 Time Points in Medicare, Report Says

Allison Inserro
The annual report, from the American Cancer Society, National Cancer Institute, the CDC, and the North American Association of Central Cancer Registries, details US cancer trends.
CMS Announces "Refresh" of CMMI With Focus on Health Equity, Fewer Models
October 20th 2021

CMS Announces "Refresh" of CMMI With Focus on Health Equity, Fewer Models

Gianna Melillo Mary Caffrey
Physician and health policy advocates praised the emphasis on streamlining models and ending silos, but practices that invested in the Oncology Care Model (OCM) await key details.
Site Logo
October 18th 2021

Comparison of the Use of Top-Ranked Cancer Hospitals Between Medicare Advantage and Traditional Medicare

Daeho Kim, PhD David J. Meyers, PhD, MPH Momotazur Rahman, PhD Amal N. Trivedi, MD, MPH
Medicare Advantage enrollees, particularly those with lower out-of-network benefits, may have restricted access to top-ranked hospitals for complex cancer care compared with traditional Medicare enrollees.
Most MA Plans in Annual CMS Report See Star Ratings Increase
October 8th 2021

Most MA Plans in Annual CMS Report See Star Ratings Increase

Allison Inserro
Ahead of Medicare open enrollment, which starts October 15, CMS released its annual report of which Medicare Advantage (MA) and Part D drug plans achieved 5-star ratings.
Jason Z. Rose, MHSA
October 4th 2021

Contributor: Why Medicare Advantage Plans Must Transform Post Discharge to Medication-Focused Transitions of Care

Jason Z. Rose, MHSA
The 2022 performance year’s Star Ratings require Medicare Advantage plans to take a more significant role in preventing readmissions.
Money graphic
October 2nd 2021

ADA vs CBO: Including Dental Coverage Under Medicare

Hayden E. Klein
The Congressional Budget Office (CBO) estimated that adding dental, vision, and hearing benefits would increase Medicare’s direct spending, but the American Dental Association (ADA) is claiming reimbursement will not be enough to cover these costs
HHS Investigation Finds Medicare Insurers Drew $9.2 Billion Through Controversial Billing Practices
September 29th 2021

HHS Investigation Finds Medicare Insurers Drew $9.2 Billion Through Controversial Billing Practices

Hayden E. Klein
One company received approximately $3.7 billion while enrolling only 22% of Medicare Advantage customers.
Study Contradicts Other Research About Potentially Inappropriate Medications Among Older Adults
September 22nd 2021

Study Contradicts Other Research About Potentially Inappropriate Medications Among Older Adults

Jaime Rosenberg
The current study found that those prescribed potentially inappropriate medications were actually less likely to revisit the emergency department within 30 days, in contrast to prior work.
BPCI Model Not Equipped to Tackle Reform of SNF Spending, Researchers Find
September 17th 2021

BPCI Model Not Equipped to Tackle Reform of SNF Spending, Researchers Find

Hayden E. Klein
The study found that BPCI Model 3, which held postacute facilities accountable for costs of care, was not associated with payment reductions or changes in other quality and selection metrics among skilled nursing facilities.
Picture of the White House
September 9th 2021

Biden Administration Drug Plan Includes Value-Based Payment Ideas for Medicare

Allison Inserro
The administration said it would make the results of its drug price negotiations with manufacturers, as well as its approach to value-based care models, open to a variety of payers.
Scott Palmer, MBA
September 6th 2021

Consumer Data Transparency Is More Important Than Ever as the Battle Against COVID Rages On

Scott Palmer, MBA
On January 1, CMS implemented the Hospital Price Transparency final rule, but by July, it was clear that many hospitals were noncompliant. Even with a proposed rule for penalties, requirements still only fall on certain parts of the health care industry.
Potentially Inappropriate Medication Use Highly Prevalent in Older Adults
September 3rd 2021

Potentially Inappropriate Medication Use Highly Prevalent in Older Adults

Hayden E. Klein
Polypharmacy may be raising the risk of inappropriate medication use, and avoiding this is crucial.
Older woman sitting on couch
August 28th 2021

Are PIMs Linked to Frailty in Older Adults?

Allison Inserro
The use of potentially inappropriate medications (PIMs) by older adults appeared to be linked to a greater risk of frailty, although the researchers said further work is needed.
older man
August 26th 2021

Addressing Polypharmacy, PIMs in Geriatric Patients With Cancer

Gianna Melillo
Researchers offer recommendations for addressing polypharmacy and potentially inappropriate medication (PIM) use among older patients with cancer.
Erin Crum, MPH
August 17th 2021

Clinicians and Payers Expect to Wait and See Before Embracing CMS’ MIPS Value Pathways

Erin Crum, MPH
DOI: 10.37765/ajmc.2021.88735
J. Thomas “Tommy” May
August 16th 2021

Contributor: Medicare Needs to Ensure People With ALS Have Access to Clinically Appropriate Respiratory Care

J. Thomas May
The pandemic has shown a spotlight on how critically important respiratory care is to Americans who struggle to breathe on their own. Yet, Medicare policy must be updated to ensure that access to lifesaving equipment will never be disrupted.
IQVIA
August 16th 2021

ASCO 2021 Recap: Health-Related Quality of Life

Mary Caffrey Matthew Gavidia
Review Describes Evidence Regarding Deprescribing Interventions for Older Patients
August 14th 2021

Review Describes Evidence Regarding Deprescribing Interventions for Older Patients

Lauren Massaro
Updated evidence provides new insight into safety, efficacy, and challenges of deprescribing.
man holding a smartphone
August 13th 2021

Smartphone App Improves Medication Adherence for Patients Needing Polypharmacy

Skylar Jeremias
Use of a smartphone-based application was found to improve medication adherence and some clinical outcomes in patients managing multiple comorbidities using polypharmacy, researchers concluded.
What We’re Reading: 2.5 Million Americans Enroll in Health Care Coverage; Telemedicine Company Owner Charged With Fraud; Hospital Staff Shortages Due to COVID-19
August 11th 2021

What We’re Reading: 2.5 Million Americans Enroll in Health Care Coverage; Telemedicine Company Owner Charged With Fraud; Hospital Staff Shortages Due to COVID-19

AJMC Staff
Late July brings a 64% enrollment increase; owner charged with fraudulently billing Medicare over $784 million; COVID-19 hot spots lose nurses due to burnout.
Links Between Polypharmacy, Clinical Frailty Seen in UK Critical Care Admissions
August 3rd 2021

Links Between Polypharmacy, Clinical Frailty Seen in UK Critical Care Admissions

Hayden E. Klein
Identifying patients with combined polypharmacy and frailty can help recognize ICU patients with high risk of hospital readmission, the authors said.
newspaper stack
August 3rd 2021

What We’re Reading: 70% of US Vaccinated; CMS Payment Rules Released; Alcohol Consumption and Cancer

AJMC Staff
Seventy percent of Americans have received at least 1 dose of a COVID-19 vaccine; CMS releases payment rules for fiscal year 2022; alcohol linked to over 700,000 new cancer diagnoses in 2020.
Picture of pharmacist with older patient
August 2nd 2021

Study Highlights Use of PIMs in US Adults With Multimorbidity, Polypharmacy

Allison Inserro
The study was conducted to shed more light on the growing issue of polypharmacy, an issue that is expected to increase as the US population ages.
Older man holding pill
July 31st 2021

Reducing Number of Drugs in Older Adults Shows Benefit 6 Months Later

Allison Inserro
Drug optimization in older adults improved outcomes in this retrospective study.
<12345678>

2 Commerce Drive
Suite 100
Cranbury, NJ 08512

© 2025 MJH Life Sciences® and AJMC®.
All rights reserved.

About
Contact
Editorial Boards
Advertise
Do Not Sell My Information
Terms & Conditions
Privacy Policy
AJMC Managed Markets Network Logo
CH LogoCenter for Biosimilars Logo