Medicare

October 28, 2024: New Living Textbook Contribution Explains Differences Between Medicare Data Sources

Posted on by Karen Staman

Living Textbook iconResearch-identifiable Medicare data can come from traditional fee-for-service Medicare claims or from Medicare Advantage claims. A new contribution to the Living Textbook of Pragmatic Clinical Trials published this month, Use of Medicare Data in PCTs, describes the important differences between these data.

At the healthcare system level, differences in incentives for documenting diagnoses can affect the reliability and relevance of data used for pragmatic clinical trials. The populations served by fee-for-service Medicare plans and Medicare Advantage plans are also disparate, as Medicare Advantage plans include a higher proportion of patients who require chronic disease management. There are also variations in enrollment rates across states and counties that reflect characteristics of the counties themselves (urban vs rural) and the firms that offer Medicare Advantage plans across regions.

Read the new contribution.

For more on using Medicare data in pragmatic trials, see the following Living Textbook sections:

July 21, 2020: Distributed Research Network Study Finds Lower Rates of Alzheimer Disease and Related Dementias in Medicare Advantage Plans

Posted on by Damon Seils

The prevalence of diagnosed Alzheimer disease and related dementias (ADRD) is lower in Medicare Advantage health insurance plans than in traditional fee-for-service Medicare, according to a new analysis of data from the NIH Collaboratory Distributed Research Network (DRN). The study was published this month in Alzheimer’s & Dementia.

NIH Collaboratory DRN HandoutMuch of the current understanding about the characteristics and experiences of people diagnosed with ADRD comes from studies of fee-for-service Medicare beneficiaries. These studies typically do not include the one-third of Medicare beneficiaries who are enrolled in Medicare Advantage plans.

In the new analysis, Jutkowitz and colleagues used data from 3 large health insurance providers that make up 30% of the Medicare Advantage health insurance market. The 3 providers are data partners in the NIH Collaboratory DRN. The researchers found that the age- and sex-stratified prevalence of ADRD among Medicare Advantage beneficiaries was lower than among fee-for-service beneficiaries. They also observed higher disenrollment rates among Medicare Advantage beneficiaries—up to 30% at 1 year—than were found in previous studies. The findings have methodological implications for research in both Medicare Advantage and fee-for-service Medicare populations.

This work was supported within the NIH Collaboratory by the NIH Common Fund through a cooperative agreement from the Office of Strategic Coordination within the Office of the NIH Director and through the NIA IMPACT Collaboratory by the National Institute on Aging. Supplemental funding was provided by the National Center for Complementary and Integrative Health. Learn more about the NIH Collaboratory DRN.

March 9, 2020: AcuOA to Inform Medicare Coverage Decisions on Acupuncture: An Interview With Dr. Karen Sherman and Dr. Lynn Debar

Posted on by Damon Seils

Evidence supporting the safety and effectiveness of treatments for chronic low back pain in older adults is lacking. Although acupuncture is known to be effective in younger adults, clinical trials of acupuncture have rarely included older adults, a population with greater comorbidity and different healthcare needs.

The Pragmatic Trial of Acupuncture for Chronic Low Back Pain in Older Adults (AcuOA), a new NIH Collaboratory Demonstration Project, will address this evidence gap by comparing acupuncture with usual care in a population of older adults with chronic low back pain. We spoke with co–principal investigators Dr. Karen Sherman and Dr. Lynn DeBar about the study at the NIH Collaboratory PRISM kickoff meeting in November.

“In an efficacy trial, you would sort out people—they would have to be healthy enough, they maybe wouldn’t have any comorbidities—and they’d get a specified course of treatment, everything would be dictated,” said Dr. Sherman. “But with older adults,” she explained, “most of the individuals would not be eligible for that kind of trial. So a pragmatic trial allows us to ask questions that are valuable to the population.”

Dr. DeBar added, “We’re really interested in how this plays out across different kinds of healthcare systems. We’re looking at this across varied delivery systems with a hope that what we find is very generalizable.”

Another aim of AcuOA is to conduct a cost-effectiveness analysis of the study’s acupuncture interventions. The study team will also conduct qualitative evaluations to describe barriers to and facilitators of the adoption, implementation, and sustainability of acupuncture treatment for older adults.

“Another interesting piece of this is that this is also for [the Centers for Medicare & Medicaid Services] to evaluate whether acupuncture will be one of the covered services under Medicare,” added Dr. DeBar. “So we will be working in some partnership with them on that,” she said.

The AcuOA trial is a project of the PRISM program (Pragmatic and Implementation Studies for the Management of Pain to Reduce Opioid Prescribing), part of the NIH’s Helping to End Addiction Long-term (HEAL) Initiative. The NIH Collaboratory serves as the PRISM Resource Coordinating Center.

“The Collaboratory has a great deal of experience doing all kinds of things, and they also seem to be quite interested in new challenges and the idea that we’re going to be giving them some new challenges,” said Dr. Sherman. “We hope to learn more about pragmatic clinical trials and moving the methodology forward,” she said.

Dr. DeBar added, “It’s also really exciting that there are 4 of these [new Demonstration Projects] that are focused on similar populations of patients, a lot of non-pharmacotherapy treatment. So, while we’re the only ones focusing exclusively on acupuncture, I think we have a lot of synergies and a lot of ability to learn from one another.”

AcOA and the NIH Collaboratory PRISM Resource Coordinating Center are supported by the National Center for Complementary and Integrative Health. Support is also provided by the NIH Common Fund through a cooperative agreement from the Office of Strategic Coordination within the Office of the NIH Director.