Work

Medicare’s hospice benefit provides comprehensive palliative care for Part A beneficiaries with terminal illnesses who elect to forgo curative care. Hospice was designed to prioritize pain management, comfort, and patient choice, but it may also generate Medicare savings by replacing costly treatments and intensive hospital care at the end of life. Drawing from high-quality studies of hospice value and timing, ATI modeled the potential effect on Medicare spending if beneficiaries currently enrolling in the eight weeks before death were to elect hospice five days earlier.

As a part of the California Department of Aging’s LTSS Financing and Affordability Initiative, ATI Advisory provided analytics and technical support — supported by actuarial analysis by Milliman — to assess whether a Medicare-based model could deliver targeted HCBS in a way that improves outcomes and reduces or does not increase Medicare costs in the longer term.

In our new issue brief, ATI Advisory examines how SNPs are fundamentally different from general MA plans, serving populations with substantially higher clinical complexity, functional impairment, and social risk. Our analysis shows SNP members have, on average, 51 percent higher risk scores than general MA members; experience higher rates of chronic illness; and more frequently experience frailty and ADL needs. SNPs operate under more rigorous federal and state requirements, invest in intensive care coordination and interdisciplinary models of care, and are more likely to deploy non-medical supplemental benefits to address functional and social needs that traditional Medicare does not cover. To create a public benchmark of these measures, ATI collected data from FDA labels, Evaluate Pharma and Omnium databases, the CMS spending dashboards, and proprietary data. For each drug, we present a high-level summary of its time on the market, use in Medicare, clinical development activity and investment, global and US sales, its position in the manufacturer’s portfolio, and deal history.

On January 27, 2026, the Centers for Medicare & Medicaid Services (CMS) announced the next round of drugs to be negotiated by Medicare. This round includes 15 drugs with negotiated prices going into effect in 2028. As CMS and pharmaceutical manufacturers prepare for negotiations, they will consider not only the effectiveness of these drugs, but also their financial performance and investment over the years. To create a public benchmark of these measures, ATI collected data from FDA labels, Evaluate Pharma and Omnium databases, the CMS spending dashboards, and proprietary data. For each drug, we present a high-level summary of its time on the market, use in Medicare, clinical development activity and investment, global and US sales, its position in the manufacturer’s portfolio, and deal history.

ATI examines how Medicare’s Drug Price Negotiation Program will affect long-term care (LTC) pharmacies. Using data from nearly 2,500 LTC pharmacies, the analysis finds that 2026–2027 negotiated drug prices could significantly reduce pharmacy revenues.

Our primer on the Program of All-Inclusive Care for the Elderly (PACE) – a capitated health plan that provides comprehensive Medicare and Medicaid covered services to frail, older adults in the community who are eligible for nursing home care – explores the latest enrollment trends and highlights latest opportunities for PACE growth.