Medicare+Choice in Palm Beach: Watching and Waiting?

Under the Medicare+Choice program, firms have been able to offer products on a county by county basis, making participation decisions based on factors such as county payment rate, strength of local provider networks, and beneficiary\u27s affinity for managed care. In 2003, Medicare+Choice payment rates paid to plans range from $495 in rural floor counties to a high of$872 in Staten Island, NY. Consequently, there is large national variation in benefits, premiums, and plan participation. A recent site visit to Palm Beach county and neighboring Miami-Dade highlighted many of the differences between counties which may pose challenges to firms trying to enter large service areas

The Importance of State Anti-Discrimination Laws on Employer Accommodation and the Movement of their Employees onto Social Security Disability Insurance

The rate of application for Social Security Disability Insurance (SSDI) benefits, as well as the number of beneficiaries has been increasing for the past several decades, threatening the solvency of the SSDI program. One possible remedy is to promote continued employment amongst those experiencing the onset of a work limiting disability through the provision of workplace accommodations. Using the Health and Retirement Study data linked to Social Security administrative records and a state fixed effects model, we find that the provision of workplace accommodation reduces the probability of application for SSDI following disability onset. We estimate that receipt of an accommodation reduces a worker’s probability of applying for SSDI by 30 percent over five years and 21 percent over 10 years. We then attempt to control for the potential endogeneity of accommodation receipt by exploiting exogenous variation in the implementation of state and federal anti-discrimination laws to estimate the impact of workplace accommodation on SSDI application in an instrumental variables (IV) model. While our coefficients continue to indicate that accommodation reduces SSDI application, we obtain implausibly large estimates of this effect. Overall our results imply that increasing accommodation is a plausible strategy for reducing SSDI applications and the number of beneficiaries.Social Security Administrationhttp://deepblue.lib.umich.edu/bitstream/2027.42/87957/1/wp251.pd

Cognitive Ability and Retiree Health Care Expenditure

Prior research indicates that retirees with less cognitive ability are at greater financial risk because they have lower incomes yet higher medical expenditures. Linking HRS data to administrative records, we evaluate two hypotheses about why this group spends more on health: (1) they are in worse health; (2) they receive more expensive or less effective care for the same conditions. We find that the bulk, but not all, of the cross-sectional relationship can be attributed to the poorer health of those with lower cognitive functioning. Much of this relationship appears to be driven by coincident declines in cognitive ability and health. While, in this respect, the data have important limitations, we find no evidence of substantial differences in care, conditional on observable health.Social Security Administrationhttp://deepblue.lib.umich.edu/bitstream/2027.42/78347/1/wp230.pd

Social Security Benefit Claiming and Medicare Utilization

Social Security Administrationhttp://deepblue.lib.umich.edu/bitstream/2027.42/102272/4/wp297-corrected.pd

The effect of tracer contact on return to care among adult, "lost to follow-up" patients living with HIV in Zambia: an instrumental variable analysis.

INTRODUCTION: Tracing patients lost to follow-up (LTFU) from HIV care is widely practiced, yet we have little knowledge of its causal effect on care engagement. In a prospective, Zambian cohort, we examined the effect of tracing on return to care within 2 years of LTFU. METHODS: We traced a stratified, random sample of LTFU patients who had received HIV care between August 2013 and July 2015. LTFU was defined as a gap of >90 days from last scheduled appointment in the routine electronic medical record. Extracting 2 years of follow-up visit data through 2017, we identified patients who returned. Using random selection for tracing as an instrumental variable (IV), we used conditional two-stage least squares regression to estimate the local average treatment effect of tracer contact on return. We examined the observational association between tracer contact and return among patient sub-groups self-confirmed as disengaged from care. RESULTS: Of the 24,164 LTFU patients enumerated, 4380 were randomly selected for tracing and 1158 were contacted by a tracer within a median of 14.8 months post-loss. IV analysis found that patients contacted by a tracer because they were randomized to tracing were no more likely to return than those not contacted (adjusted risk difference [aRD]: 3%, 95% CI: -2%, 8%, p = 0.23). Observational data showed that among contacted, disengaged patients, the rate of return was higher in the week following tracer contact (IR 5.74, 95% CI: 3.78-8.71) than in the 2 weeks to 1-month post-contact (IR 2.28, 95% CI: 1.40-3.72). There was a greater effect of tracing among patients lost for >6 months compared to those contacted within 3 months of loss. CONCLUSIONS: Overall, tracer contact did not causally increase LTFU patient return to HIV care, demonstrating the limited impact of tracing in this program, where contact occurred months after patients were LTFU. However, observational data suggest that tracing may speed return among some LTFU patients genuinely out-of-care. Further studies may improve tracing effectiveness by examining the mechanisms underlying the impact of tracing on return to care, the effect of tracing at different times-since-loss and using more accurate identification of patients who are truly disengaged to target tracing

Project title: Geographic Variation in Disability Insurance Application and Awards in the Wake of the Coronavirus Epidemic

Despite concerns that the enormous economic and health consequences of the COVID pandemic would increase Social Security disability benefit claiming, applications dropped during the first nine months of the pandemic. This paper uses Social Security Administration data on new program applicants and current beneficiaries to characterize age and impairment changes among applicants in the post-COVID-19 period and trends in death rates among Disability Insurance and Supplemental Security Income recipients. In the post-COVID-19 period, program disability applicants were nearly half a year younger than usual and recipients experienced death rates that were 15% to 24% higher than earlier years. Neither differences in telework rates nor excess mortality appeared to explain these results. Additional research is necessary to track these patterns across additional pandemic variants.The Social Security Administration through the Michigan Retirement and Disability Research Center award RDR18000002-03, UM21-02http://deepblue.lib.umich.edu/bitstream/2027.42/192624/1/wp460.pdfDescription of wp460.pdf : working paperSEL

Can Food Stamps help to reduce Medicare spending on diabetes?

Diabetes is rapidly escalating amongst low-income, older adults at great cost to the Medicare program. We use longitudinal survey data from the Health and Retirement Study linked to administrative Medicare records and biomarker data to assess the relationship between Food Stamp receipt and diabetes health outcomes. We find no significant difference in Medicare spending, outpatient utilization, diabetes hospitalizations and blood sugar (HbA1c) levels between recipients and income-eligible non-recipients after controlling for a detailed set of covariates including individual fixed effects and measures of diabetes treatment compliance. As one-third of elderly Food Stamp recipients are currently diabetic, greater coordination between the Food Stamp, Medicare, and Medicaid programs may improve health outcomes for this group.Diabetes Food Stamps Biomarker data Elderly Medicare spending