The purpose of the proposed Program Project is to undertake a fundamental examination of the theoretical and empirical underpinnings of Medicare Part C, or Medicare Advantage (MA) from a framework grounded in economic theory. The Project is organized around five projects that relate to three levels of a multi-stage game: 1) At the lowest level, beneficiaries choose MA or traditional Medicare (TM) depending on plan offerings;2) At the middle level, plans decide about entry and choose the overall generosity of benefits, depending upon Medicare policy and accounting for beneficiary reaction;3) Also at the middle level, plans choose the mix or structure of their benefits, depending upon Medicare policy and in light of possible opportunities for efficiencies from integration and incentives due to imperfect risk adjustment, accounting for beneficiary reaction (selection);4) Also at the middle level, MA plan choices about entry and practice patterns have consequences for beneficiaries in TM and non-Medicare populations;this empirical project focuses on these spillovers;5) At the highest level, the fifth project is theoretical, focusing on design optimal policies for Medicare given plan and beneficiary reaction, and potential spillovers investigated in the empirical projects. The significance of the proposed research is premised on four observations. First, the Medicare program is of enormous importance to the elderly in the United States, affecting their health, their financial status, and overall welfare. Second, the Medicare program is of broad importance to the federal government because of its budgetary impact. Third, MA, a critical and growing part of Medicare, is arguably failing to achieve its objective of providing high-quality care with greater efficiency than TM. The June 2007 Report to Congress of the Medicare Payment Advisory Commission (MedPAC) flatly concluded: """"""""The current MA payment policy is inconsistent with MedPAC's principles of payment equity between MA and the traditional FFS program."""""""" Fourth, a well-designed MA program has the power to move Medicare into a position of leadership in health policy, while a poorly-designed program will stifle attempts at positive reform.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Research Program Projects (P01)
Project #
Application #
Study Section
Special Emphasis Panel (ZAG1-ZIJ-9 (O2))
Program Officer
Baker, Colin S
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Harvard University
Schools of Medicine
United States
Zip Code
McWilliams, J Michael; Gilstrap, Lauren G; Stevenson, David G et al. (2017) Changes in Postacute Care in the Medicare Shared Savings Program. JAMA Intern Med 177:518-526
García-Albéniz, Xabier; Hsu, John; Bretthauer, Michael et al. (2017) Effectiveness of Screening Colonoscopy to Prevent Colorectal Cancer Among Medicare Beneficiaries Aged 70 to 79 Years: A Prospective Observational Study. Ann Intern Med 166:18-26
McWilliams, J Michael (2017) MACRA: Big Fix or Big Problem? Ann Intern Med 167:122-124
Neprash, Hannah T; Chernew, Michael E; McWilliams, J Michael (2017) Little Evidence Exists To Support The Expectation That Providers Would Consolidate To Enter New Payment Models. Health Aff (Millwood) 36:346-354
McWilliams, J Michael; Schwartz, Aaron L (2017) Focusing on High-Cost Patients - The Key to Addressing High Costs? N Engl J Med 376:807-809
Newhouse, Joseph P (2017) Risk adjustment with an outside option. J Health Econ 56:256-258
Grabowski, David C; Joyce, Nina R; McGuire, Thomas G et al. (2017) Passive Enrollment Of Dual-Eligible Beneficiaries Into Medicare And Medicaid Managed Care Has Not Met Expectations. Health Aff (Millwood) 36:846-854
Ganguli, Ishani; Souza, Jeffrey; McWilliams, J Michael et al. (2017) Trends in Use of the US Medicare Annual Wellness Visit, 2011-2014. JAMA 317:2233-2235
Roberts, Eric T; Zaslavsky, Alan M; McWilliams, J Michael (2017) The Value-Based Payment Modifier: Program Outcomes and Implications for Disparities. Ann Intern Med :
Glazer, Jacob; McGuire, Thomas G (2017) Paying Medicare Advantage plans: To level or tilt the playing field. J Health Econ 56:281-291

Showing the most recent 10 out of 69 publications