The Kaiser Family Foundation recently released an issue brief which compares the expected value of benefits for individuals ages 65 and older under Medicare's fee-for-service program to two "typical" plans offered by large employers: a typical large employer preferred provider organization (PPO) plan and the Blue Cross/Blue Shield Standard Option for enrollees in the Federal Employees Health Benefits Program (FEHBP), also a PPO plan. The analysis updates a 2008 Kaiser Family Foundation report that found...

According to a new Government Accountability Office (GAO) report, Medicare is spending $8 billion on an experimental program that rewards providers of less than stellar health care. The report recommends that the Obama administration cancel the demonstration program, which pays bonuses to health insurance companies caring for millions of Medicare beneficiaries. The administration defended the project, arguing that it could improve care quality for older Americans. The Affordable Care Act (ACA) cut Medicare payments to managed care plans, known as Medicare Advantage (MA), and authorized bonus payments to those that provide high-quality care. However, the GAO letter reports that the majority of the money paid under the demonstration program went to “average-performing plans” rated lower than Congress's benchmarks. GAO reported that the project would cost $8.35 billion over 10 years, with 80 percent of the cost occurring in the first three years. Although the project dwarfs other Medicare demonstrations in its budgetary impact, the GAO report found that the project is so poorly designed that researchers could not determine whether the bonus payments correlated with improved care. As a result, the report argues, the project is unlikely to produce meaningful results. Currently, over 12 million Americans are enrolled in MA plans. About one-third of them are in plans that would receive bonuses under the original ACA. Under the demonstration project, 90 percent are in plans eligible for bonuses. Another report released the same day by...

The Measure Applications Partnership (MAP), a public-private group of stakeholders working with the National Quality Forum (NQF) submitted the report, "Strategic Approach to Performance Measurement for Dual Eligible Beneficiaries," to the Department of Health and Human Services (HHS) to detail potential health care quality measures for dual eligibles under the Affordable Care Act (ACA). Dual eligible members account for a disproportionate share of Medicare and Medicaid spending. While dual eligibles make up only 15% of Medicaid enrollees, they account for 39% of all Medicaid expenditures. Similarly, dual eligibles account for 16% of Medicare enrollees and 27% of program expenditures. The MAP report proposes a broad outline for measuring health care quality for dual eligibles and for identifying difficulties in obtaining comprehensive treatment data. The five measures of quality that HHS could use to improve care and control spending for dual eligibles include 1) quality of life, 2) care coordination, 3) screening and assessment, 4) mental health and substance abuse, and 5) structural measures.

The AARP has released a new study analyzing care management practices in integrated care models serving dual eligibles.