Within the context of Medicare’s enunciated triple aims of better health, better care, and lower costs, we examine the effectiveness of medical loss ratio (MLR) on health outcomes of Medicare Advantage insurers. We simultaneously examine the effect of an efficiency measure for the insurer...

The recent final rule on Medicaid managed care establishes the minimum medical loss ratio (MLR) requirement for Medicaid managed care and contains several provisions to strengthen delivery and payment reforms and improve efficiency and quality of care. Accordingly, this research examines the...

Medicare Accountable Care Organizations (ACOs) represent the nation’s largest initiative of Medicare alternative payment models toward value and health outcomes. The Centers for Medicare & Medicaid Services (CMS) have tested various ACO models with differential risk structures, and have issued...