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
Daw, Jamie R; Hatfield, Laura A (2018) Matching and Regression to the Mean in Difference-in-Differences Analysis. Health Serv Res 53:4138-4156
Barnett, Michael L; McWilliams, J Michael (2018) Changes in specialty care use and leakage in Medicare accountable care organizations. Am J Manag Care 24:e141-e149
Roberts, Eric T; Hatfield, Laura A; McWilliams, J Michael et al. (2018) Changes In Hospital Utilization Three Years Into Maryland's Global Budget Program For Rural Hospitals. Health Aff (Millwood) 37:644-653
Gilstrap, Lauren G; Huskamp, Haiden A; Stevenson, David G et al. (2018) Changes In End-Of-Life Care In The Medicare Shared Savings Program. Health Aff (Millwood) 37:1693-1700
McWilliams, J Michael; Hatfield, Laura A; Landon, Bruce E et al. (2018) Medicare Spending after 3 Years of the Medicare Shared Savings Program. N Engl J Med 379:1139-1149
Roberts, Eric T; McWilliams, J Michael; Hatfield, Laura A et al. (2018) Changes in Health Care Use Associated With the Introduction of Hospital Global Budgets in Maryland. JAMA Intern Med 178:260-268
Schwartz, Aaron L; Zaslavsky, Alan M; Landon, Bruce E et al. (2018) Low-Value Service Use in Provider Organizations. Health Serv Res 53:87-119
Ganguli, Ishani; Souza, Jeffrey; McWilliams, J Michael et al. (2018) Practices Caring For The Underserved Are Less Likely To Adopt Medicare's Annual Wellness Visit. Health Aff (Millwood) 37:283-291
Chen, Julius L; Hicks, Andrew L; Chernew, Michael E (2018) Prices for physician services in Medicare Advantage versus traditional Medicare. Am J Manag Care 24:341-344
Landon, Bruce E; Zaslavsky, Alan M; Souza, Jeffrey et al. (2018) Trends in Diabetes Treatment and Monitoring among Medicare Beneficiaries. J Gen Intern Med 33:471-480

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