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Hospice Medicare Margins: Analysis of Patient and Hospice Characteristics, Utilization, and Cost25 November 2019 - By Carol Bazell and Melissa A. Caplen and William Coates and Pamela M. Pelizzari and Bruce S. Pyenson - Article

This report is an analysis of how hospices’ Medicare margins relate to the characteristics of the Medicare patients served and the characteristics of the hospice itself, focusing on hospice ownership status.

Medicare cost of osteoporotic fractures11 September 2019 - By Dane Hansen and Carol Bazell and Pamela M. Pelizzari and Bruce S. Pyenson - Article

This report discusses the economic and clinical burden of new osteoporotic fractures that occurred in 2015 in the Medicare fee-for-service population using information from a large administrative medical claims database.

The real-world Medicare costs of Alzheimer disease: Considerations for policy and care28 June 2019 - By Bruce S. Pyenson and Charles Steffens - Article

This article compares total Medicare-covered (allowed) costs of patients with Alzheimer disease with the risk-adjusted costs of beneficiaries without dementia over their last years of life, using claims data.

No apparent workup for most new indeterminate pulmonary nodules in US commercially-insured patients13 May 2019 - By Javier J.Zulueta and Bruce S. Pyenson and Carol Bazell and Michael J. Bellanich and Melissa A. Caplen - Article

This article examines the pattern and cost of indeterminate pulmonary nodule workup in real-world practice using insurer administrative claims for commercially insured individuals.

A world without rebates? How will the Part D market react to the new proposed safe harbor for rebates?27 March 2019 - By Bruce S. Pyenson and Amy Kwong - Article

This paper describes how the proposed rule to eliminate the long-standing safe harbor protection for prescription drug rebates paid to Medicare Part D sponsors and pharmacy benefit managers may affect the Medicare Part D market.

Multiple sclerosis: New perspectives on the patient journey: 2019 update20 March 2019 - By Bruce S. Pyenson and Samantha Tomicki - Article

Claims-based predictive modeling may help identify patients at risk for multiple sclerosis and assess disease burden.

Applying machine learning techniques to identify undiagnosed patients with exocrine pancreatic insufficiency14 February 2019 - By Feng Han and Jaime Vora and Jeffrey Gomberg and Monica Son and Motoharu Dei and Nikhil Khandelwal and Bruce S. Pyenson and Maggie Alston - Article

This study develops a machine learning model that identifies patients in a commercial medical claims database who likely have exocrine pancreatic insufficiency but are underdiagnosed.

Can voluntary POS rebates work for Medicare Part D?12 February 2019 - By Jennifer Carioto and Gabriela Dieguez and Bruce S. Pyenson - Article

This report examines why Medicare Part D plans that share manufacturer rebates at the point of sale under a voluntary system will likely have a rather high premium relative to market averages.

Including dementia in the Part C Medicare risk adjuster: Health services issues11 February 2019 - By Bruce S. Pyenson and Charles Steffens - Article

The Centers for Medicare and Medicaid Services released its proposed 2020 risk score methodology for Medicare Advantage plans in December, and it describes proposed updates to the existing Hierarchical Condition Category (HCC) risk adjustment model and suggests an alternative model, which includes two HCCs for dementia.

The utility of ICER reports for private payer budgeting: Budget impact analyses17 January 2019 - By Tia Goss Sawhney and Bruce S. Pyenson and Eric Buzby - Article

This report identifies several disconnects between the Institute for Clinical and Economic Review’s work and its potential use by private payers to analyze the impact of new drugs on their budgets.

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