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Under traditional Medicare, the Centers for Medicare and Medicaid Services (CMS) pays providers separately for each service delivered, which may incentivize medically unnecessary care.  Providers who participate in CMS’s Bundled Payment for Care…

Misuse of opioid analgesics threatens public health and results in rising numbers of overdose deaths and admissions to emergency departments and treatment facilities. In the absence of adequate patient information systems, patients who engage in “doctor…

When individuals need long-term care, information on provider quality is critical to making an informed choice. The major ongoing challenge in the project is preparing the monthly updates to Care Compare and its Five-Star Quality Rating System to support…

The Ryan White HIV/AIDS Program (RWHAP), administered by the Health Resources and Services Administration (HRSA), provides services to support comprehensive care for people living with HIV and AIDS. Despite improvements in testing, linkage, and…

Changes in the complex prospective payment system (PPS) for home health agencies (HHAs) may have led to HHA behavior changes that thwarted the modifications’ goals. As a result, the Centers for Medicare & Medicaid Services (CMS) wanted an assessment of…

The misuse of opioids is a national crisis. One aspect of the larger problem relates to prescription opioids for Medicare beneficiaries. The Centers for Medicare & Medicaid Services (CMS) needs to evaluate trends to fight potential fraud, waste, and…

Medicaid provides critical assistance that enables people with limited resources and incomes to access acute and preventive medical care and long-term services and support. Innovations that simultaneously improve care for beneficiaries and promote…

CMS launched the Accountable Health Communities (AHC) Model to address the gap between clinical care and community services in the health care system. The AHC Model is based on emerging evidence that addressing health-related social needs can improve…

The prevalence of opioid use disorder (OUD) among pregnant women and the incidence of neonatal opioid withdrawal syndrome (NOWS) due to in-utero exposure to opioids have soared over the past two decades. The prevalence of NOWS among infants enrolled in…

A high number of non-urgent cases that could be addressed by general practice (GP) doctors are presenting unnecessarily at hospital emergency departments (EDs); these are potentially avoidable. Strategies that can save ED health professionals’ time also…