Unbiased Analysis of Today's Healthcare Issues
In May 2025, CMS’s Center for Medicare & Medicaid Innovation (CMMI) unveiled it’s “Make America Healthy Again” vision. CMMI models focus on not only “protecting the federal taxpayer,” but also (i) promoting evidence-based prevention, (ii) empowering people to achieve their health goals, and (iii) driving choice and competition for people. CMMI has introduced a number…
The number of hospitals owned by private equity (PE) firms has increased in recent years. One key question is how increased PE ownership has impact quality of care. To answer the question, a Jiao 2025 Health Services Research paper used claims Medicaid claims data–specifically data from the Transformed Medicaid Statistical Information System (T-MSIS) and Medicaid…
This is one of the fundamental questions in health policy in recent years. Quality can be measured in two parts. First, does quality improved for targeted patients? Second, does quality improve for non-targeted patients. The first question is relatively clear. One would think that quality would improve for the patients targeted by a pay-for-performance (P4P)…
The answer is ‘yes’ according to a paper by Borrelli et al. (2025). The authors use annual Medicare Star Rating health plan performance for Medicare Advantage-Part D (MAPD) plans over the past decade (2015 to 2024). They find that: For plans achieving at least 4 stars on the medication adherence measures, 70%-74% of them also…
How best can you design an outcomes based agreement (OBA)? What are the key factors to consider? Project IDEATE is a “cross-disciplinary collaboration between National Health Service (NHS) Wales, industry and academia” with the aim to develop and refine OBA models. This initiative is described in Burton et al. (2024). What were the key factors…
That is the question posted by a recent paper by Li and Dor (2024). However, they define competition not just by the number of community health center (CHC) competitors or market concentration (e.g., Herfindahl-Hirschman Index, HHI) but also the quality of care provided by their competitors. A key methodological question is how this should be…
That is the clever title of recent American Economic Review publication by Cyrus Aghamolla, Pinar Karaca-Mandic, Xuelin Li, Richard T. Thakor. The abstract is below. This study examines the link between credit supply and hospital health outcomes. We use bank stress tests as exogenous shocks to credit access for hospitals that have lending relationships with…
My FTI colleagues Mark Van Ert and Krunal Patel summarize some of the new quality measures that will be incorporated into the 2025 CMS Star Ratings that are used to evaluate Medicare Advantage (MA) plans. The CMS Star Ratings are very important as CMS payments to MA plans is expected to increase by 3.7% or…
Out of more than 50 alternative payment models (APM) that CMS has implemented only six have shown statistically significant cost savings and only four of these met the requirements to be expanded in duration and scope. That is not my opinion, CMS itself states this. We all want higher quality at lower cost; so the…
This is the title of a new paper I have out today at JMCP with co-authors Shanshan Wang, Jaehong Kim, Slaven Sikirica, and Alexander Sandhu with the subtitle “An economic model measuring the impact of sotagliflozin among patients with heart failure and diabetes“. The abstract is below: BACKGROUND: Heart failure (HF) is among the leading…