Michael E. Chernew
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Health Economist. Professor, Harvard Medical School. Tweets reflect my views alone and not those of any organization I am affiliated with, including MedPAC
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Articles by Michael E. Chernew
Ensuring a Sustainable Medicare Program Through Effective Oversight
Medicare is a trillion-dollar government program that covers 70 million lives through either traditional Medicare (TM) or Medicare Advantage (MA). In contrast to TM, which pays clinicians directly using a system of fee schedules, MA is based on a system of competing private plans that contract with the government and then pay clinicians.
Insurer Retention of Stand-Alone Part D Plan Enrollees Switching to Medicare Advantage
Supplement. Table 1.
GLP-1 Prescriptions for Weight Loss by Differences in Insurance Plan Coverage
Introduction Coverage of glucagon-like peptide-1 (GLP-1) drugs for weight loss is controversial.
Year 1 Impact of Offering Non‐Emergency Medical Transportation on Care Utilization Among Low‐Income and Disabled Beneficiaries in Medicare Advantage
Disclosure Dr. McWilliams reports research support outside the submitted work from institutional research grants or institutional gifts for research and education from the Agency for Healthcare Research and Quality, the Commonwealth Fund, and Humana; personal income from Oak Ridge Associated Universities for services as a senior adviser to the Center for Medicare and Medicaid Innovation; personal income for serving as a consultant to RTI International, Analysis Group, Action Now Initiative,...
Incidence, Persistence, and Steady‐State Prevalence in Coding Intensity for Health Plan Payment
What is known on this topic ○ Medicare incentivizes providers and insurers to code for as many diagnoses per beneficiary as possible, contributing to billions of dollars of Medicare program spending. ○ Empirical research indicates that the frequency of diagnostic coding in Medicare has increased steadily in recent years. ○ Current measures of coding practices for a given diagnosis largely count the prevalence, or the proportion of beneficiaries with a specified code, in one time period.
Incidence, Persistence, and Steady‐State Prevalence in Coding Intensity for Health Plan Payment
What is known on this topic ○ Medicare incentivizes providers and insurers to code for as many diagnoses per beneficiary as possible, contributing to billions of dollars of Medicare program spending. ○ Empirical research indicates that the frequency of diagnostic coding in Medicare has increased steadily in recent years. ○ Current measures of coding practices for a given diagnosis largely count the prevalence, or the proportion of beneficiaries with a specified code, in one time period.
MedPAC’s analytic agenda for the 2025-2026 meeting cycle
This Thursday, MedPAC kicks off the 2025-2026 meeting cycle when we convene our September public meeting. For our September meeting, we are delighted to welcome the Comptroller General of the United States and head of the U.S. Government Accountability Office (GAO), Gene Dodaro, who will present GAO’s work on reducing improper payments and improving the sustainability of the Medicare program.
Missing Author Affiliation
Missing Author Affiliation Organization and Performance of US Health Systems Nancy D. Beaulieu, PhD; Michael E. Chernew, PhD; J. Michael McWilliams, MD, PhD; Mary Beth Landrum, PhD; Maurice Dalton, MA; Angela Yutong Gu, MA; Michael Briskin, BA; Rachel Wu, BA; Zakaria El Amrani, BA; Helene Machado, BS; Andrew L. Hicks, MA; David M.
Medicare at 60: Suggestions for balancing access to care and financial protections with fiscal concerns
For 60 years, Medicare has been a cornerstone of the American social insurance system, protecting millions of aged, blind, and disabled people from high health care costs and ensuring access to necessary services.
MedPAC’s analytic agenda for the 2024-2025 meeting cycle
This Thursday, MedPAC kicks off the 2024-2025 meeting cycle when we convene our September meeting. We are excited to share some of the policy issues MedPAC will be working on during the coming months. MedPAC’s agenda is shaped by a combination of statutory requirements, congressional interest, and the interests of the Commission, at the direction of MedPAC’s Chair and Executive Director.
Reduced Cost Sharing and Medication Management Services for COPD
Key Points Question How does a program providing large reductions in beneficiary cost sharing for maintenance inhalers and medication management services affect adherence and other outcomes among patients with chronic obstructive pulmonary disease?
MedPAC mourns the passing of Gail Wilensky
MedPAC > News > General announcements > MedPAC mourns the passing of Gail Wilensky The Medicare Payment Advisory Commission mourns the passing of Gail Wilensky, MedPAC’s founding Chair. Gail led the Commission from 1997 through 2003, establishing the agency’s mission and direction which we rely on to this very day. Gail brought focus, energy, and rigor to the work of improving the Medicare program for the millions of beneficiaries who depend upon it.
How Should Medicare Pay For Artificial Intelligence?
Artificial intelligence (AI) has the potential to transform many aspects of the health care system.1,2 One manifestation of this has been the rapid introduction of AI-enabled clinical services, which integrate AI at the point of care to help clinicians provide diagnoses for, treat, or triage patients. More than 500 such services have been approved by the US Food and Drug Administration,3 and payers have begun reimbursing clinicians for their use.
Parsing The Debate Around The Medicare Advantage/Traditional Medicare Payment Gap
The Medicare Payment Advisory Commission (MedPAC) is a non-partisan, independent agency that provides Congress with policy and technical advice to improve the Medicare program. The Commission has long supported including Medicare Advantage (MA) plans in Medicare. As MA enrollment has grown to over half of eligible beneficiaries, discussion about payment to MA plans has become increasingly important.
Prices for Common Services at Quaternary vs Nonquaternary Hospitals
Prices for Common Services at Quaternary vs Nonquaternary Hospitals Addressing Excess Health Care Pricing With Backstop Price Caps Michael E. Chernew, PhD; Maximilian J.
MedPAC’s analytic agenda for the 2023-2024 meeting cycle
We are excited to share some of the policy issues MedPAC will be working on during the 2023–2024 meeting cycle. MedPAC’s agenda is shaped by a combination of statutory requirements, congressional interest, and the interests of the Commission, at the direction of MedPAC’s Chair.
Greetings from Paul Masi
Greetings, My name is Paul Masi, and I am excited to return to MedPAC as the next Executive Director. Leading the staff at MedPAC is a great honor, and I want to thank Mike Chernew and Amol Navathe for this opportunity. I also want to thank Jim Mathews for his long service to MedPAC, including his leadership in the Executive Director role since 2017. Leading the Commission through these last several years has required Jim to navigate unprecedented challenges.
Industry Voices—Why more healthcare can be harmful to your health
We often view providing more healthcare as beneficial, but sometimes it can be harmful—physically, mentally and financially—for the patient and their family. As members of the healthcare community, we’ve known about the problem of “low-value” care—care that provides no benefit, or where the risk of harm outweighs any potential benefits—for decades, and yet the healthcare industry has not been able to solve this systemic issue.
Michael Chernew
As members of the healthcare community, we’ve known about the problem of “low-value” care for decades, and yet have not been able to solve this issue.
Association of Evaluation and Management Payment Policy Changes With Medicare Payment to Physicians by Specialty
Key Points Question Were the 2021 changes in evaluation and management (E/M) payment policies associated with redistribution of Medicare payments from procedural specialists to primary care physicians?
Organization and Performance of US Health Systems
Organization and Performance of US Health Systems Hospitals, Market Share, and Consolidation David M. Cutler, PhD; Fiona Scott Morton, PhD Administrative Simplification and the Potential for Saving a Quarter-Trillion Dollars in Health Care Nikhil R. Sahni, BA, BAS, BSe, MBA, MPA/ID; Brandon Carrus, BS, MSc; David M. Cutler, AB, PhD Disentangling the Role of Health Care Systems in Producing High-Quality Care Valerie A. Lewis, PhD; Genevra F. Murray, PhD; Darren A.
Seven Burning Questions Related To Commercial Prices For Health Care Services
Editor’s Note: Today, Health Affairs is pleased to launch a new Forefront series, Provider Prices in the Commercial Sector, featuring analysis and discussion of physician, hospital, and other health care provider prices in the private-sector markets and their contribution to overall spending therein. The series kicks off with this article by Michael Chernew and Victoria Berquist and another piece by Erin Fuse Brown. Additional articles will be published throughout 2023.
Two Approaches to Capping Health Care Prices
High health care prices for the privately-insured contribute to high premiums, which put downward pressure on wages, and induce employers to reduce benefit generosity and charge employees more for coverage. As the average annual premium for family coverage currently exceeds $22,000, many U.S. states are interested in policies that would lower prices for care. Here, we discuss two strategies to limit health care prices: comprehensive price caps supported by rate review and out-of-network price cap.
Two Approaches To Capping Health Care Prices
Prices for health care services in the commercial sector in the US are high and vary widely within and across geographic markets. High prices contribute to high premiums, which put downward pressure on wages, and induce employers to reduce benefit generosity and charge employees more for coverage. As the average annual premium for family coverage currently exceeds $22,000, many US states are interested in policies that would lower prices for care.
The Case For ACOs: Why Payment Reform Remains Necessary
Medicare population-based payment models, broadly known as accountable care organization (ACO) models, of which the Global and Professional Direct Contracting Model (GPDC) is an example, were launched out of recognition of two largely inherent weaknesses of fee-for-service: FFS does not promote efficiency, nor does it promote equity.
Hierarchical Payment Models-A Path for Coordinating Population- and Episode-Based Payment Models
In November 2021, the Centers for Medicare & Medicaid Services (CMS) announced a strategy to achieve near-universal participation in value-based payment models by 2030.1 Core to this strategy is the goal that every beneficiary should be in a clinical care relationship that has accountability for quality and total cost of care.
American Economic Association
« Back to Results Paper Session Friday, Jan. 7, 2022 10:00 AM - 12:00 PM (EST) Hosted By: Health Economics Research Organization Chair: Michael Chernew, Harvard University What Do Insurers Do Differently than One Another?
Administrative Expenses in the US Health Care System
A variety of studies over the last 2 decades have found that administrative expenses account for approximately 15% to 25% of total national health care expenditures, an amount that represents an estimated $600 billion to $1 trillion per year of the total national health expenditures of $3.8 trillion in 2019.1 Billing and coding costs, physician administrative activities, and insurance administrative costs are the primary drivers of these expenses.2,3 In a new study, Sahni et al4 estimated...
Challenges In Interpreting The Evidence On Medicare Alternative Payment Models
Medicare’s share of gross domestic product, projected to grow by over 50 percent by 2050, is among the federal government’s leading long-term fiscal challenges. Alternatives to fee-for-service reimbursement, such as accountable care organizations (ACOs) and episode-based payments, offer the promise of “bending the trend” through provider-driven reductions in low-value care rather than benefit reductions or fee cuts.
Physician Practice Interruptions in the Treatment of Medicare Patients During the COVID-19 Pandemic
Viewpoint Outpatient Home Treatment for Medicare Beneficiaries Before and After The COVID19 Pandemic Justin E. Bekelman, MD; Ezekiel J. Emanuel, MD; Amol S. Navathe, MD, PhD Research Letter Primary Care Payment Model and Telemedicine Use for Medicare Advantage During the COVID-19 Pandemic Brian W. Powers, MD; Dana Drzayich Antol, MS; Yongming Zhao, PhD; Gilbert S. Haugh, MS; Oraida Roman, MHA; William H. Shrank, MD; Niteesh K.
Paying patients to use lower‐priced providers
Objective Many employers have introduced rewards programs as a new benefit design in which employees are paid $25–$500 if they receive care from lower-priced providers. Our goal was to assess the impact of the rewards program on procedure prices and choice of provider and how these outcomes vary by length of exposure to the program and patient population.
Using Consistently Low Performance to Identify Low-Quality Physician Groups
Key Points Question Can quality measures identify low-quality physician groups when performance is correlated across multiple measures or multiple years? Findings In this cross-sectional study of a commercially insured population with diabetes or cardiovascular disease, we found weak consistency of low performance scores across multiple measures but moderate to strong consistency of scores over multiple years.
Assessment of Patient Attribution to Care From Medical Oncologists, Surgeons, or Radiation Oncologists After Newly Diagnosed Cancer
Introduction As payers implement value-based payments for oncology care, assignment of patients to physician practices is increasingly important to accurately assess quality and reimburse clinicians accordingly. Yet, patient attribution remains a challenge.1 Most claims-based attribution algorithms assign patients to practices based on the plurality of primary care visits. However, clinician attribution for specialty care is complex.
A Path Forward for Alternative Payment—Build a Portfolio Not a Garden
Although alternative payment models (APMs) have existed for decades, in 2010 the Affordable Care Act accelerated their development and adoption. In particular, the Affordable Care Act launched the Medicare Shared Savings Program for Accountable Care Organizations (ACOs) and created the Centers for Medicare and Medicaid Innovation (CMMI).
Regulation of Health Care Prices: The Case for Backstop Price Caps in Commercial Health Care Markets
Prices for health care in the commercial sector in the US are high by many standards. Considerable research documents that these prices exceed prices paid in other countries and by Medicare, which are, in theory, set to approximate costs for the efficient delivery of care. Moreover, commercial prices vary widely between and within markets.
Physician Work Hours and the Gender Pay Gap — Evidence from Primary Care | NEJM
Article Figures/Media Metrics Related Articles Background The gender gap in physician pay is often attributed in part to women working fewer hours than men, but evidence to date is limited by self-report and a lack of detail regarding clinical revenue and gender differences in practice style.
The Role of Market Forces in U.S. Health Care
PerspectiveFundamentals of U.S. Health PolicyFree Preview The Role of Market Forces in U.S. Health Care List of authors. Michael E. Chernew, Ph.D.
Physician Work Hours and the Gender Pay Gap — Evidence from Primary Care | NEJM
Study Design and Overview We conducted a cross-sectional analysis of primary care visits using a national sample of deidentified all-payer claims and EHR data for 2011 through 2017. The data were supplied by athenahealth, a technology company that provides Internet-based medical billing, practice management, and EHR software. The study was approved by institutional review boards at the National Bureau of Economic Research and the University of Minnesota.
Contributions Of Public Health, Pharmaceuticals, And Other Medical Care To US Life Expectancy Changes, 1990-2015
Information © 2020 Project HOPE—The People-to-People Health Foundation, Inc. ACKNOWLEDGMENTS All authors report grant support from Pharmaceutical Research and Manufacturers of America. Jason Buxbaum reports research support from the Agency for Healthcare Research and Quality (Grant No. T32-HS000055). Buxbaum has received consulting income from the University of Michigan.
Supporting Health Care Delivery In Low-Income Areas During COVID-19
COVID-19 has created significant financial hardship for health care providers. To minimize the risk of disease transmission, clinicians have deferred in-person visits and postponed elective procedures. When possible, they have relied on telehealth to avoid disruptions in care. Yet, even with telehealth payment parity, providers have not made up for lost revenue. In mid-May, the number of outpatient visits, including telehealth, was still a third lower than before the pandemic.
Rebates in the Pharmaceutical Industry: Evidence from Medicines Sold in Retail Pharmacies in the U.S.
Author Abstract Rising list prices are often used to illustrate the burden of prescription drug spending, but payers routinely negotiate rebates from manufacturers that generate differences between list and net prices. List prices are easily available but net prices are confidential. We use novel data on medicines sold in a retail setting to quantify rebate growth, the sensitivity of pharmaceutical price indices to list versus net prices, and contribution of net price growth to revenue growth.
Wide State-Level Variation In Commercial Health Care Prices Suggests Uneven Impact Of Price Regulation
The authors gratefully acknowledge research support from the Commonwealth Fund. The views presented here are those of the authors and not necessarily those of the Commonwealth Fund, its directors, officers, or staff. Michael Chernew reports being a partner in V-BID Health and a small equity interest in Virta Health and Archway Health.
Physician Organization and the Role of Workforce Turnover
Background: Physicians increasingly work in large practices that are integrated into hospital systems (1, 2). Although the role of mergers and acquisitions in driving this trend has received much attention, changes in practice composition may also play a role if older physicians are more likely to leave small practices (3) and newer physicians are more likely to join larger ones (4).
American Economic Association
« Back to Results Paper Session Sunday, Jan.
How Different Payment Models Support (or Undermine) a Sustainable Health Care System: Rating the Underlying Incentives and Building a Better Model
There are many layers of payment in the health care system as a whole. The most salient nexus for creating the right incentives for utilization of care — and therefore the part of the system most in need of reform — is how funds flow from insurers to the organizations that deliver care. From the perspective of health care economics, the authors review the evidence around three leading payment models and rate each on criteria desirable to providers, payers, and patients.
Spending Reductions in the Medicare Shared Savings Program: Selection or Savings?
From the Department of Health Care Policy, Harvard Medical School (JMM, MEC, BEL, LAH, PH); Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School (JMM); and Division of General Internal Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center (BEL), all in Boston, MA.
New Evidence on Public and Private Accountable Care Organizations
New Evidence on Public and Private Accountable Care Organizations Tuesday, June 25, 2019: 1:30 PM-3:00 PM Madison B (Marriott Wardman Park Hotel) Chair: Michael E. Chernew
A Hospital System’s Wellness Program Linked To Health Plan Enrollment Cut Hospitalizations But Not Overall Costs
Cardiovascular disease, diabetes mellitus, hypertension, and chronic lung diseases are among the leading causes of disability and mortality in the United States. 1 It is widely believed by policy makers that effective promotion of wellness will contribute to health improvement and mitigate health care cost increases. Many employers offer voluntary health screenings, fitness and smoking cessation programs, and other preventive services.
Paying Patients To Switch: Impact Of A Rewards Program On Choice Of Providers, Prices, And Utilization
Information © 2019 Project HOPE—The People-to-People Health Foundation, Inc. ACKNOWLEDGMENTS This research was supported by a grant from the Laura and John Arnold Foundation. The views presented here are those of the authors and not necessarily those of the Laura and John Arnold Foundation, its directors, officers, or staff.
Little Evidence Exists To Support The Expectation That Providers Would Consolidate To Enter New Payment Models
This research was previously presented at the Sixth Biennial Conference of the American Society of Health Economists, Philadelphia, Pennsylvania, June 13, 2016, and the AcademyHealth Annual Research Meeting, Boston, Massachusetts, June 27, 2016.
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