# Improving Medicare in an Era of Change

> **NIH NIH P01** · HARVARD MEDICAL SCHOOL · 2020 · $2,124,410

## Abstract

PROJECT SUMMARY/ABSTRACT
Successfully integrating the financing and delivery of care remains a primary goal of the Medicare program
after years of expanding efforts, including a recent period of unprecedented experimentation. The resulting
changes in Medicare have created opportunities to understand how payment systems affect patient care and
outcomes. The Medicare Advantage (MA) program is Medicare's most significant attempt to integrate financing
and care. Currently 36% of beneficiaries are enrolled in capitated private plans that can influence patient care
and outcomes through multiple mechanisms, including selective contracting, benefit design, and care
management. Given that the majority of beneficiaries remain in Traditional Medicare (TM), Medicare has
implemented efforts to integrate financing and care in that program as well, including alternative payment
models (APMs) in which Medicare risk-contracts with providers directly. The evidence on the merits of MA is
largely observational, and little is known about the relative performance of APMs. Moreover, the implications of
integrated financing and delivery for patients remain unclear and understudied. Until recently, data on the MA
program were insufficient to support detailed empirical exploration of differences in care patterns and the
potential mechanisms driving them. Potential lessons abound from state Medicaid programs, which typically
use narrower provider networks than MA plans and have increasingly delegated care management to private
plans, but the relative impact on patient care of approaches taken in Medicaid and Medicare have not been
quantified. There is recognition across the various integration initiatives that one size does not fit all; payments
that are prospective, or incorporate prospective elements, give plans and providers greater flexibility in
selecting inputs of care to support patients' health and well-being. But the implications for patients with special
needs are poorly understood. Many challenges remain in payment system design and performance monitoring,
particularly in methods of risk adjustment. Thus, as Medicare innovates and evolves, sound analysis is needed
to generate an evidence base for understanding how payment systems affect patients. This Program Project,
“Improving Medicare in an Era of Change,” focuses on the consequences of a changing Medicare program for
patient care and outcomes. It intends to supply foundational insights for designing payment systems in health
care. Our research agenda encompasses four key areas: 1) comparative performance of MA and TM and
variants of each; 2) strategies employed by MA plans; 3) learning from state Medicaid programs; and 4)
experiences of Medicare patients with dementia and their implications for payment system refinements for
patients with special needs. Our proposal builds on our current Program Project by leveraging new data
sources and empirical approaches to: examine previously unanswerable questions; sup...

## Key facts

- **NIH application ID:** 9937239
- **Project number:** 2P01AG032952-11
- **Recipient organization:** HARVARD MEDICAL SCHOOL
- **Principal Investigator:** Bruce E. Landon
- **Activity code:** P01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $2,124,410
- **Award type:** 2
- **Project period:** 2009-04-15 → 2025-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9937239

## Citation

> US National Institutes of Health, RePORTER application 9937239, Improving Medicare in an Era of Change (2P01AG032952-11). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9937239. Licensed CC0.

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