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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Through AHIP, Payers Vow to Rein in Prior Authorization, but Doctors Have Doubts

August 20th 2025

Health insurers commit to reforming prior authorization processes, aiming to enhance patient care and reduce burdens on providers, impacting millions.

PACE participants | Image: National PACE Association
PACE Program Expansion Requires For-Profit Investment, Reduced Regulatory Burden, and Greater Patient Eligibility

August 19th 2025

For Community Oncology, Good News in Physician Fee Schedule Offset by Potential Wreckage of MFP Proposal
For Community Oncology, Good News in Physician Fee Schedule Offset by Potential Wreckage of MFP Proposal

August 1st 2025

PA form | Image: Adobe Stock
KFF Survey: Most Consumers Find Prior Authorization Is a Major Problem

July 25th 2025

Physician burnout | WaveBreakMediaMicro for Adobe
Commentary: Americans Can’t Afford to Lose Access to Their Doctors

July 24th 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

Top 5 Medicare 2021
December 25th 2021

Top 5 Most-Read Medicare Articles of 2021

Christina Mattina
This year’s most-read articles on Medicare covered topics including accountable care organizations, value-based payment, and star ratings.
A. Mark Fendrick, MD
December 20th 2021

Covering Key Cancer Services Before Deductible Would Help Close Gaps, Fendrick Says

Mary Caffrey
Coverage from the 2021 COA Payer Exchange Summit.
COA logo
December 20th 2021

A Rapid-Fire Look at How Pharma, Practices Are Embracing Oncology Reform

Mary Caffrey
Coverage from the 2021 COA Payer Exchange Summit.
Computer Algorithm May Be Able to Detect Potentially Inappropriate Prescribing
December 18th 2021

Computer Algorithm May Be Able to Detect Potentially Inappropriate Prescribing

Jaime Rosenberg
The findings come from an algorithm that was based on 4 criteria-based tools, including 2 widely-used measures designed to ferret out inappropriate medication prescribing in older adults.
Jackson Williams, JD
December 17th 2021

Contributor: Should Insurance Regulation Be Used to Promote Nontraditional Goals?

Jackson Williams, JD
Three policies to revamp insurance consumer protections for health care delivery are explored, with highlighted areas for improvement being maternal health coverage and loosening of network adequacy requirements.
What We're Reading
December 8th 2021

What We’re Reading: Pfizer Efficacy Against Omicron; Congress Plan to Lift Debt Ceiling; COVID-19 Impact on Mental Health Crisis

AJMC Staff
Antibodies produced by vaccinated people may be less successful at fighting against Omicron compared with other variants; Congressional leaders created a plan to lift the debt limit with only Democratic votes in the Senate, staving off Medicare cuts; cases of depression and anxiety among youths both doubled during the pandemic.
syringe and pills
December 4th 2021

High Rates of Polypharmacy-Associated Adverse Events Seen in Those Aging With HIV

Gianna Melillo
People aging with HIV have more drug–drug interactions compared with those without HIV, according to results of an observational study.
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December 2nd 2021

An Analysis of Medicare Accountable Care Organization Expense Reports

Catherine Hersey, MPH J. Michael McWilliams, MD, PhD Betty Fout, PhD Matthew J. Trombley, PhD Lauren Scarpati, PhD
The authors of this study examined expense reports to understand how participants in Medicare’s Accountable Care Organization Investment Model spent to achieve program goals.
Melissa Andel, MPP
November 25th 2021

Melissa Andel on Adding Dental, Hearing, Vision Benefits to Medicare

It’s right to acknowledge that dental, hearing, and vision are important for total health care for Medicare beneficiaries, said Melissa Andel, MPP, vice president of health policy at CommonHealth Solutions.
With No Replacement for OCM on Horizon, Oncology Practices Ask: What Now?
November 22nd 2021

With No Replacement for OCM on Horizon, Oncology Practices Ask: What Now?

Gianna Melillo
The announcement of a "strategic refresh" for payment models under the Center for Medicare and Medicaid Innovation offered no details on what practices should expect when the Oncology Care Model (OCM) expires in 2022.
clipart images of an apple, pill bottle, healthcare forms, doctors, hand holding a heart, piggy bank with a calculator, and a stack of money
November 20th 2021

US Oncology Network, Tennessee Oncology Tout Medicare OCM Savings

Skylar Jeremias
A report from the Centers for Medicare and Medicaid Innovation confirmed that practices within the US Oncology Network and Tennessee Oncology participating in the Oncology Care Model (OCM) program have contributed significant savings to the agency.
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.
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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.
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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.
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