Kelly E. Anderson, MPP
I am a health services researcher focused on measuring the effects of Medicare insurance design on price, utilization, and quality of health care.
I am currently a 4th year PhD candidate in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health.
My dissertation research studies access to, and utilization of, physician-administered drugs for enrollees with fee-for-service coverage compared to Medicare Advantage coverage. Physician-administered (or Part B) drugs account for about 10% of Part B spending and are gaining increasing attention because spending on these drugs is growing about 9% a year. In prior work as part of the Johns Hopkins Drug Access and Affordability Initiative, I have found that the reimbursement system under fee-for-service (FFS), where providers receive an add-on payment as a percentage of the drug cost, leads providers to select higher-cost formulations when lower-cost formulations are available. There is no existing work looking at the use of physician-administered drugs within MA. In my first aim, I use MA encounter data and Medicare FFS claims to compare utilization for enrollees with FFS vs. MA coverage. In my second aim, I look at a specific purchasing mechanism (white/brown bagging) which moves payment for these drugs to the pharmacy benefit and allows MA insurers to negotiate the price. While there is evidence that this commonly occurs in the commercial space, there is no evidence on how commonly this is occurring for enrollees in MA-PD plans and Part D standalone plans or the effects on spending. In my third aim, I look at two benefit-design mechanisms MA insurers may use to control spending on physician-administered drugs, provider network design and formulary design.
Separately, using the OptumLabs data I am working on a series of papers evaluating the quality of care for individuals with OUD with Medicare Advantage coverage compared to commercial coverage.
I also study Medicare Advantage provider network development and regulation. This stream of research builds on my prior contract research work with the Division of Medicare Advantage Operations (DMAO) within CMS on the refinement of MA network adequacy criteria and monitoring.
Finally, in response to the COVID-19 pandemic, I am part of the Johns Hopkins University team fielding and analyzing the Johns Hopkins COVID-19 Civic Life and Public Health Survey.
Get in touch at firstname.lastname@example.org