This document is an overarching view of project goals and research questions. For an up-to-date list of specific to-do items and work in progress, see our GitHub Issues or weekly update.
At its heart, this project seeks to gain a deeper understanding of where and how United States Medicare tax dollars are being spent. Healthcare is an increasingly important issue for many Americans; the Centers for Medicare and Medicaid Services estimate nearly 41 million Americans were enrolled in Medicare prescription drug coverage programs as of October 2016.[1]
Because healthcare spending is a very real concern, we want to make it real - not just for people who like reading graphs and looking at statistics, but for everybody. We're harnessing the power of data and modern computing to find answers to the questions people keep asking, and to make those answers clear and easy to understand - questions like:
- Which conditions are we spending the most to treat?
- How much are people paying out of their own pockets for prescription drugs?
- What could Medicare and the American people do to save money, while also ensuring the same quality of care?
In conducting this research, we hope to gain new insights and create a positive impact for healthcare consumers and providers across the United States.
Medicare is a US government health care program for Americans age 65 and older, as well as a few smaller groups. Goals 1-3 are primarily driven by the data that inspired this project: data released by the Centers for Medicare & Medicaid Services to describe, in aggregate, prescription counts and spending for Medicare Parts B and D between 2011 and 2015.
Goal 1: Understand how Medicare-related US taxpayer dollars are spent and how this program directly affects older Americans
Medicare is a huge expenditure for the federal government, paid for in part by US citizens’ taxes; in 2015, it accounted for 15% of the federal budget.[2] We want to help the public understand what these funds are paying for and how this program affects our older generation (and, by extension, all Americans), specifically relating to prescription costs and claims.
We’ll answer questions like:
- What are the most common conditions that Medicare pays to treat, and how many older Americans are affected by them?
- What proportion of Medicare prescription spending/claims is spent on, for example, diabetes medications? How has this changed over time?
- How much does Medicare spend on brand-name drugs vs generics, where available?
- Medicare recipients are still responsible for some out-of-pocket prescription costs even after receiving their benefits. How much does a typical Medicare recipient pay for a given prescription? How does this differ for patients who receive a low-income subsidy vs those who do not?
With a few years of prescription data, we can see how prescribing practice and prices change for a condition, drug class or specific formulation. Some examples of what we’re looking for:
- New medications or classes changing prescribing habits
- Competition between brand names affecting costs
- Introduction of generics leading to less brand name use and lower overall spending, even with the same number of prescriptions
- Evolution of clinical practice - for example, more awareness of a condition means more diagnoses and thus more prescriptions
- Changes in the financial or legislative realms (company mergers or partial convergence of the “doughnut hole”, for example)
Seeing a spending pattern can raise a lot of questions: What caused a big spike in a particular brand-name drug’s cost in a certain year? Why did the number of prescriptions for all drugs in a particular class seem to suddenly get higher?
By combining CMS data with additional information, we can help the public understand changes in spending and prescribing patterns. Examples might include:
- Change in Medicare rules allowing coverage of benzodiazepines in 2013 (link)
- Price spike after a specific brand of medication is acquired by a new company (example)
- A generic form of a popular brand-name drug becomes available
- Clinical guideline changes
- More broadly: Out of all Medicare spending, how much is on Part D (outpatient prescriptions)? Part B (inpatient prescriptions)?
These questions don’t have obvious data sources as of yet, but are most definitely of interest to us and to the public. We’ll look for data sources to help refine and answer these questions as well.
What one individual pays for a certain medication can vary widely depending on his or her health care coverage, pharmacy, and use of coupons or other discount programs. We’d like to describe this variation in costs, look for factors that contribute to it, and find opportunities to make the public more aware of available resources.
Medicaid is another US government health program which provides health insurance for low-income families and individuals. It is jointly funded and run by the federal and state governments, so data structures as well as the conclusions we draw might vary from state to state. We’d like to answer questions similar to our Medicare goals for this program.
Drug development is undeniably incredibly expensive; do the medications which took the most in R&D spending also cost the most to insurance companies/government programs/individuals?
- Hoadley, Jack; Cubanski, Juliette; and Neuman, Tricia. “Medicare Part D in 2016 and Trends Over Time.” Kaiser Family Foundation, http://kff.org/report-section/medicare-part-d-in-2016-and-trends-over-time-section-1-part-d-enrollment-and-plan-availability/ . Accessed January 31, 2017.
- Cubanski, Juliette, and Neuman, Tricia. “The Facts on Medicare Spending and Financing.” Kaiser Family Foundation, http://kff.org/medicare/issue-brief/the-facts-on-medicare-spending-and-financing/ . Accessed January 31, 2017.