Medicare at a Crossroads

The Methods & Theory Core aims to develop and apply innovative statistical methods, economic theory, and distributional analysis tools to enhance research on Medicare policies and their impact on the health and health care of older adults. Through its position as an intellectual hub within the Program Project, the Core will foster collaboration across the five constituent research projects, provide critical analytical support, develop new methodological techniques, and facilitate training and learning opportunities within and outside the Program Project. Core investigators will advance methods for casemix adjustment by tackling mismeasurement due to differential coding practices and data limitations. The Core will also develop weighting estimators equivalent to regression-based estimators in common designs like event study and mover designs. This will enable casemix adjustment that relies less on parametric assumptions and can be connected to modern causal inference techniques to approximate randomized controlled trials. Through this methods development, the Core will provide the Project teams with robust tools to account for population health differences. The Core will develop economic theory that incorporates behavioral frictions and modifications to standard motives, giving a more complete and realistic characterization of the welfare trade-offs of policy choices. These will advance economic theory in optimal social insurance, benefit design and payment, and physician agency. This will strengthen the Project teams’ ability to consider the tradeoffs and consequences of policy design decisions. The Core will develop rigorous definitions of populations of interest, causal frameworks, and analytical tools for estimating differential impacts of policy and program changes across groups. This will provide Project teams with the tools to analyze the distributional consequences of key program design choices. The Core will also house a Training & Learning Lab to both disseminate the findings of the Program Project research teams to stakeholder communities and train the next generation of Medicare scholars. Through these methods and theory advancements, the Core will advance the scientific evidence informing Medicare policy to improve health care access, affordability, and outcomes for older adults. This directly addresses the mission of the National Institute on Aging by generating actionable insights on enhancing program design and delivery to serve all beneficiaries.