Quality Measures

With the Medicare open enrollment period set to begin Oct. 15, a perennial decision faced by Medicare beneficiaries is whether to get their coverage through traditional Medicare or the private plans known as Medicare Advantage. A new KFF review of 62 studies published since 2016 that compares Medicare Advantage and…

This literature review examines 62 studies published since 2016 that compare Medicare Advantage and traditional Medicare based on measures of beneficiary experience, affordability, service utilization, and quality.

The COVID-19 pandemic has raised awareness and sharpened the discussion of systemic racial disparities in the U.S. health care system. These inequities existed long before the pandemic and have been recognized for decades, yet they continue and, in some cases, have worsened. Cancer consistently ranks as one of the leading…

State Medicaid programs are using managed care and an array of other service delivery and payment system reforms, financial incentives, and managed care contracting requirements to help achieve better outcomes and lower costs. This brief examines what delivery system and payment reform initiatives are in place across states; how are states linking financial incentives and using transparency to improve quality and outcomes; and how are states leveraging managed care plan contracts to advance delivery system and payment reform initiatives.

The private plans known as Medicare Advantage now cover more than 4 in 10 Medicare beneficiaries, reflecting a more than doubling of enrollment over the past decade even as the plans remain a far larger presence in some states than others, according to a new KFF analysis. More than 26…

In 2021, 81 percent of all Medicare Advantage enrollees are in plans that receive a bonus payment from Medicare based on star quality ratings (or because they are new), substantially higher than the share in 2015 (55 percent). Annual bonus payments from the federal government to Medicare Advantage insurers have increased correspondingly, quadrupling from $3 billion in 2015 to $11.6 billion in 2021.

This issue brief discusses four key issues related to long-term services and supports (LTSS) including institutional and home and community-based services (HCBS) quality, highlighting major legislative and policy changes over the last 30 years since the passage of the Nursing Home Reform Act.

For the first time, 1 in every 3 people with Medicare is enrolled in Medicare Advantage, the private Medicare plans that have played an increasingly large role in the Medicare program over the past decade, according to a new analysis from the Kaiser Family Foundation. Medicare Advantage enrollment has more…

This Data Spotlight reviews national and state-level enrollment trends as of March 2017 and examines variation in enrollment by plan type and firm. It analyzes the most recent data on premiums, out-of-pocket limits, Part D cost-sharing for drugs, and plans’ quality ratings for Medicare Advantage enrollees.

This primer providers an overview of certain delivery system reform models that are being examined in traditional Medicare, and explains model goals, financial incentives, potential beneficiary implications, and results so far with respect to Medicare spending and care quality. The primer discusses accountable care organizations, medical homes and bundled payments.