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

By Giuliana Grossi

March 28th 2025

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.

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CGM Adherence and Costs Improve With DME Channel Over Pharmacy

By Hayden E. Klein

March 26th 2025

Texas Oncology to Roll Out Canopy for ePROs After Head-to-Head Pilot

By Mary Caffrey
Rose McNulty

March 18th 2025

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More Care Doesn't Equal Happier Patients in Traditional Medicare

By Maggie L. Shaw

March 17th 2025

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Oz Confirmation Hearing Probes Vision for Medicaid but Coalesces Around Well-Being

By Christina Mattina

March 14th 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

March 17th 2022

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

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.

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.

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.

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

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.

March 3rd 2022

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

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

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

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

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

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.

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.

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.

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

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.

February 3rd 2022

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

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.

February 2nd 2022

Inability to Access Health Care Due to COVID-19 Among Medicare Beneficiaries

Chanhyun Park, PhD Boon Peng Ng, PhD Kiyoung Kim, PhD

Up to one-fifth of Medicare beneficiaries were unable to access health care due to the COVID-19 pandemic in 2020.

Geoffrey Boyce

January 31st 2022

Array CEO Geoffrey Boyce Discusses AtHome Telebehavioral Health Services

Hayden E. Klein

Geoffrey Boyce, CEO of Array Behavioral Care, discusses Array AtHome’s telebehavioral health services, which are now available to approximately 5 million Humana Medicare Advantage members.

January 27th 2022

What We’re Reading: Omicron-Specific Vaccine Trials; Health Insurance Enrollment Gains; Public Nursing Home Staffing Data

Pfizer and Moderna announced commencement of trials for Omicron-specific booster shots; 14.5 million Americans gained health coverage since November 2021; Medicare’s website for consumers to research nursing home staffing is up and running.

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January 26th 2022

Number of Accountable Care Organizations Joining MSSP in 2022 Grew Slightly, CMS Says

Allison Inserro

In its annual Medicare Shared Savings Program (MSSP) report, CMS said the number of accountable care organizations joining increased, but a trade group said the results should have been better.

pills

January 24th 2022

Study Finds High Polypharmacy Rates Among Those With History of Depression

Results of a study carried out in Iran found those with a recent history of depressive disorders were more likely to suffer from polypharmacy, or taking 5 or more medications concurrently.

What We're Reading

January 21st 2022

What We’re Reading: Unvaccinated Seniors at Higher Risk for Hospitalization, Nursing Homes in Crisis; Alzheimer Groups Protest

Unvaccinated older adults are 49 times more likely to be hospitalized after contracting COVID-19; nursing homes are experiencing a major staffing crisis; major Alzheimer groups plan to meet with federal officials and lawmakers to protest the CMS drug proposal.

Pills being weighed

January 19th 2022

Polypharmacy Linked With Rehospitalization, Death Among Patients With HF

An analysis conducted in Japan among patients with acute decompensated heart failure (HF) revealed excessive polypharmacy at hospital discharge is associated with an increased risk of mortality after 1 year.

Jason Z. Rose, MHSA

January 16th 2022

Contributor: Technology-Based Telepharmacy Needed to Engage High-risk Patients, Improve Medication Adherence

Jason Z. Rose, MHSA

Medicare Advantage plans must leverage data-driven insights and omnichannel telepharmacy software to guide meaningful interactions with high-risk members and boost Star Ratings performance.

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