Differences In Use Of Services And Quality Of Care In Medicare Advantage And Traditional Medicare, 2010 And 2017.
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ABSTRACT:
SUBMITTER: Landon BE
PROVIDER: S-EPMC10171780 | biostudies-literature | 2023 Apr
REPOSITORIES: biostudies-literature
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Differences In Use Of Services And Quality Of Care In Medicare Advantage And Traditional Medicare, 2010 And 2017.
Landon Bruce E BE Zaslavsky Alan M AM Anderson Timothy S TS Souza Jeffrey J Curto Vilsa V Ayanian John Z JZ
Health affairs (Project Hope) 20230401 4
Medicare Advantage (MA) enrollment growth could make it difficult for MA plans to maintain their track record of limiting discretionary utilization while delivering higher-quality care than traditional Medicare. We compared quality and utilization measures in Medicare Advantage and traditional Medicare in 2010 and 2017. Clinical quality performance was higher in MA health maintenance organizations (HMOs) and preferred provider organizations (PPOs) than in traditional Medicare for almost all meas ...[more]
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Project description:ImportanceBetter evidence is needed on whether Medicare Advantage (MA) plans can control the use of postacute care services while achieving excellent outcomes.ObjectiveTo compare self-reported use of postacute care services and outcomes among traditional Medicare (TM) beneficiaries and MA enrollees.Design, setting, and participantsThis cohort study used data from the National Health and Aging Trends Study (NHATS) with linked Medicare enrollment data from 2015 to 2017. Participants were community-dwelling MA or TM beneficiaries 70 years and older; those with dual Medicare and Medicaid eligibility were also identified. Analyses were conducted from May 2022 to February 2023 and were weighted to account for the complex survey design.ExposuresEnrollment in MA and dual eligibility for Medicare and Medicaid.Main outcomes and measuresPostacute care service use including site of use, duration, primary indication, and whether participants met their goals or experienced improved functional status during or after services.ResultsIncluded in the analysis were 2357 Medicare beneficiaries who used postacute care. Of these beneficiaries, 815 (32.6%; 62.0% were females [weighted percentages]) had MA and 1542 (67.4%; 59.5% were females [weighted percentages]) had TM. Enrollees in MA reported using postacute care services across all NHATS survey rounds: between 16.2% (95% CI, 14.3%-18.4%) and 17.7% (95% CI, 15.4%-20.4%) of MA enrollees reported using postacute care services each round, vs 22.4% (95% CI, 20.9%-24.1%) to 24.1% (95% CI, 21.8%-26.6%) of TM beneficiaries (P for all rounds <.002). Enrollees in MA reported less functional improvement during postacute care use (63.1% [95% CI, 59.2%-66.8%] vs 71.7% [95% CI, 68.9%-74.3%], P < .001). Among beneficiaries who ended postacute service use, fewer MA enrollees than TM enrollees reported that they met their goals (70.5% [95% CI, 65.1%-75.3%] vs 76.2% [95% CI, 73.1%-79.1%]; P = .053) or had improved functional status (43.9% [95% CI, 38.9%-49.1%] vs 46.0% [95% CI, 42.5%-49.5%]; P = .42), but differences were not statistically significant. Differences in postacute care use and functional improvement were not statistically significant between MA and TM enrollees with dual eligibility.Conclusions and relevanceIn this cohort study of Medicare beneficiaries, we found that MA enrollees overall used less postacute care services than their TM counterparts. Among users of postacute care services, MA enrollees reported less favorable outcomes compared with TM enrollees. These findings highlight the importance of assessing patient-reported outcomes, especially as MA and other payment models seek to reduce inefficient use of postacute care services.
| S-EPMC10439482 | biostudies-literature
Project description:ImportancePrivate Medicare Advantage (MA) plans recently surpassed traditional Medicare (TM) in enrollment. However, MA plans are facing scrutiny for burdensome prior authorization and potential rationing of care, including home health. MA beneficiaries are less likely to receive home health, but recent evidence on differences in service intensity and outcomes among home health patients is lacking.ObjectiveTo examine differences in home health service intensity and patient outcomes between MA and TM.Design, setting, and participantsThis cross-sectional study was conducted from January 2019 to December 2022 in 102 home health locations in 19 states and included 178 195 TM and 107 102 MA patients 65 years or older with 2 or fewer 60-day home health episodes. It included a secondary analysis of standardized assessment and visit data. Inverse probability of treatment weighting regression compared service intensity and patient outcomes between MA and TM episodes, accounting for differences in demographic characteristics, medical complexity, functional and cognitive impairments, social environment, caregiver support, and local community factors. Models included office location, year, and reimbursement policy fixed effects. Data were analyzed between September 2023 and July 2024.ExposureTM vs MA plan.Main outcomes and measuresHome health length of stay and number of visits from nursing, physical, occupational, and speech therapy, social work, and home health aides. Patient outcomes included improvement in self-care and mobility function, discharge to the community, and transfer to an inpatient facility during home health.ResultsOf 285 297 total patients, 180 283 (63.2%) were female; 586 (0.2%) were American Indian/Alaska Native, 8957 (3.1%) Asian, 28 694 (10.1%) Black, 7406 (2.6%) Hispanic, 1959 (0.7%) Native Hawaiian/Pacific Islander, 237 017 (83.1%) non-Hispanic White, and 678 (0.2%) multiracial individuals. MA patients had shorter home health length of stay by 1.62 days (95% CI, -1.82 to 1.42) and received fewer visits from all disciplines except social work. There were no differences in inpatient transfers. MA patients had 3% and 4% lower adjusted odds of improving in mobility and self-care, respectively (mobility odds ratio [OR], 0.97; 95% CI, 0.94-0.99; self-care OR, 0.96; 95% CI, 0.92-0.99). MA patients were 5% more likely to discharge to the community compared with TM (OR, 1.05; 95% CI, 1.01-1.08).Conclusions and relevanceThe results of this cross-sectional study suggest that MA patients receive shorter and less intensive home health care vs TM patients with similar needs. Differences may be due to the administrative burden and cost-limiting incentives of MA plans. MA patients experienced slightly worse functional outcomes but were more likely to discharge to the community, which may have negative implications for MA patients, including reduced functional independence or increased caregiver burden.
| S-EPMC10907922 | biostudies-literature
Project description:ObjectivesTo compare the prices paid to physicians by employer-sponsored Medicare Advantage (MA) plans with those paid by traditional Medicare (TM) and to determine whether the relationship between MA and TM prices is affected by the generosity of MA benchmarks.Study designDescriptive analysis of medical claims data from the 2014-2015 MarketScan Medicare Claims Database.MethodsWe focus on claims for low-complexity office visits with an established patient (Current Procedural Terminology [CPT] code 99213) and electrocardiograms (CPT code 93000). For a given service, we identify the prices paid by MA plans and by TM in a metropolitan statistical area (MSA), which is our definition of a market. We then construct an MA-to-TM price ratio for each MSA and report the median price ratio. In a subanalysis, we disaggregate the result for office visits by MA benchmark generosity.ResultsFor both services, the estimated median price ratio is close to 1.00. We also find that even as MA benchmarks (relative to local fee-for-service spending) increase, the median price ratio for office visits remains close to 1.00.ConclusionsAfter analyzing claims for common physician services, we find that employer-sponsored MA plans pay prices that are similar to TM rates. This holds even as the generosity of MA plan payment changes. Similarity between MA and TM prices appears to be stable over time, despite recent policy changes. Our findings emphasize the important role that TM plays in the MA market and that TM payment changes could have a spillover effect on MA prices and spending.
| S-EPMC6053627 | biostudies-literature
Project description:The use of home-based medical care differed in Medicare Advantage and traditional Medicare in 2018. Having exactly one such visit was thirty-one times as likely for Medicare Advantage beneficiaries (18.6 percent) as for traditional Medicare beneficiaries (0.6 percent), likely reflecting incentives in the Medicare Advantage program to code all accurate diagnoses. Multiple home-based medical care visits were less likely in Medicare Advantage than in traditional Medicare (1.6 percent versus 2.1 percent of beneficiaries, respectively).
| S-EPMC10947452 | biostudies-literature
Project description:ImportanceThe Medicare Advantage (MA) program has doubled in size during the past decade, and enrollment among adults with low income has increased rapidly. Such adults face significant barriers in accessing care, leading to poorer health outcomes. Therefore, understanding how health care access, preventive care, and care affordability compare for adults with low income who are enrolled in MA vs traditional Medicare (TM) is critically important.ObjectiveTo compare measures of health care access, preventive care use, and affordability of care between adults with low income who are enrolled in MA vs TM.Design, setting, and participantsThis nationally representative cross-sectional study used the 2019 National Health Interview Survey to compare 2622 adults aged 65 years or older with low income who were enrolled in MA vs TM. Data were analyzed from December 5, 2021, to April 10, 2022.Main outcomes and measuresMeasures of health care access, preventive care use, and health care affordability.ResultsThe study cohort included 2622 adults aged 65 years or older with low income, resulting in a weighted cohort of 14 222 243 adults, of whom 5 641 049 (39.7%) were enrolled in MA and 8 581 194 (60.3%) in TM. The overall age of the cohort was 74.6 years (95% CI, 74.3-74.9). Between the MA and TM groups, the mean age (74.5 years [95% CI, 74.1-75.0] vs 74.7 years [95% CI, 74.3-75.1]; P = .63) and sex distribution (63.6% women [95% CI, 59.8%-67.3%] vs 60.4% women [95% CI, 57.4%-63.3%]; P = .17) were similar, but adults with low income in MA were more likely to be non-Hispanic Asian (7.6% [95% CI, 5.0%-10.1%] vs 3.8% [95% CI, 2.4%-5.3%]; P = .01) or Hispanic (18.1% [95% CI, 14.3%-21.9%] vs 9.4% [95% CI, 7.2%-11.7%]; P < .001). Adults with low income in MA compared with those enrolled in TM were more likely to have a usual place of care (97.7% vs 94.9%; adjusted odds ratio [aOR], 2.37 [95% CI, 1.38-4.07]), but similarly likely to have a recent physician visit (95.5% vs 93.5%; aOR, 1.39 [95% CI, 0.88-2.17]) and to delay medical care (5.3% vs 5.7%; aOR, 0.83 [95% CI, 0.56-1.24]) or not seek medical care (5.6% vs 5.9%; aOR, 0.86 [95% CI, 0.56-1.30]) due to costs. For preventive care measures, adults with low income in MA were more likely than those in TM to have undergone a recent cholesterol screening (98.7% vs 96.6%; aOR, 2.58 [95% CI, 1.27-5.22]). However, there were no significant differences between the MA and TM groups in the likelihood of diabetes screening (90.6% vs 87.6%; aOR, 1.21 [95% CI, 0.87-1.66]), blood pressure screening (96.8% vs 95.2%; aOR, 1.37 [95% CI, 0.84-2.23]), or receipt of an influenza vaccination in the past year (66.3% vs 63.8%; aOR, 1.16 [95% CI, 0.93-1.45]). Adults with low income in MA or TM were similarly likely to be concerned about paying medical bills (47.3% vs 44.2%; aOR, 1.09 [95% CI, 0.88-1.35]) or have problems paying medical bills (17.1% vs 17.2%; aOR, 0.94 [95% CI, 0.69-1.27]) and were also similarly likely to delay filling prescriptions (7.4% vs 6.2%; aOR, 1.22 [95% CI, 0.78-1.92]) or to not fill prescriptions (7.8% vs 7.4%; aOR, 1.01 [95% CI, 0.70-1.45]) due to costs.Conclusions and relevanceIn this study of Medicare beneficiaries with low income, key measures of health care access, preventive care use, and health care affordability generally did not differ between those enrolled in MA vs TM.
| S-EPMC9175080 | biostudies-literature
Project description:ImportanceLow-value care in the Medicare program is prevalent, costly, potentially harmful, and persistent. Although Medicare Advantage (MA) plans can use managed care strategies not available in traditional Medicare (TM), it is not clear whether this flexibility is associated with lower rates of low-value care.ObjectivesTo compare rates of low-value services between MA and TM beneficiaries and explore how elements of insurance design present in MA are associated with the delivery of low-value care.Design, setting, and participantsThis cross-sectional study analyzed beneficiaries enrolled in MA and TM using claims data from a large, national MA insurer and a random 5% sample of TM beneficiaries. The study period was January 1, 2017, through December 31, 2019. All analyses were conducted from July 2021 to March 2022.ExposuresEnrollment in MA vs TM.Main outcomes and measuresLow-value care was assessed using 26 claims-based measures. Regression models were used to estimate the association between MA enrollment and rates of low-value services while controlling for beneficiary characteristics. Stratified analyses explored whether network design, product design, value-based payment, or utilization management moderated differences in low-value care between MA and TM beneficiaries and among MA beneficiaries.ResultsAmong a study population of 2 470 199 Medicare beneficiaries (mean [SD] age, 75.6 [7.0] years; 1 346 777 [54.5%] female; 229 107 [9.3%] Black and 2 126 353 [86.1%] White individuals), 1 527 763 (61.8%) were enrolled in MA and 942 436 (38.2%) were enrolled in TM. Beneficiaries enrolled in MA received 9.2% (95% CI, 8.5%-9.8%) fewer low-value services in 2019 than TM beneficiaries (23.1 vs 25.4 total low-value services per 100 beneficiaries). Although MA beneficiaries enrolled in health management organization and preferred provider organization products received fewer low-value services than TM beneficiaries, the difference was largest for those enrolled in health management organization products (2.6 fewer [95% CI, 2.4-2.8] vs 2.1 fewer [95% CI, 1.9-2.3] services per 100 beneficiaries, respectively). Across primary care payment arrangements, MA beneficiaries received fewer low-value services than TM beneficiaries, with the largest difference observed for MA beneficiaries whose primary care physicians were reimbursed within 2-sided risk arrangements.Conclusions and relevanceIn this cross-sectional study of Medicare beneficiaries, those enrolled in MA had lower rates of low-value care than those enrolled in TM; elements of insurance design present in the MA program and absent in TM were associated with reduction in low-value care.
| S-EPMC9463603 | biostudies-literature
Project description:ImportanceMedicare Advantage (MA) has entailed a major expansion of government-financed, privately administered health insurance in the US. As policy makers consider options to expand Medicare further, it is informative to compare the performance of traditional Medicare (TM) and MA.ObjectiveTo assess whether MA is associated with differential changes in health care utilization and spending for beneficiaries entering Medicare from commercial insurance compared with beneficiaries entering TM.Design setting and participantsThis retrospective cohort study with a difference-in-differences analysis and propensity score matching compared health care utilization and spending between beneficiaries enrolling in MA and beneficiaries enrolling in TM with a Medicare Supplement plan 1 year before vs 1 year after their initial Medicare enrollment. Participants included beneficiaries aged 65 to 70 years who remained enrolled with a large insurer when transitioning from commercial insurance to Medicare between June 2018 and December 2018. Data were analyzed from February 2020 to October 2021.Main outcomes and measuresUse of, and spending on, institutional (Part A) and professional (Part B) medical services, measured as overall spending per member per month, and as rates of services per thousand members per year, including inpatient stays, inpatient days, physician visits, and injectable drug administrations.ResultsAmong 1082 matched beneficiaries (541 joining MA, 541 joining TM with a Supplement plan), 585 (54.1%) were female, and the mean (SD) age at Medicare enrollment was 66 (1.4) years. Prior to Medicare enrollment, there was no statistically significant difference in outcome trends between the MA and TM groups. The first year of MA enrollment was associated with a differential reduction in institutional (Part A) spending of $95 (95% CI, $7-$183) per member per month, corresponding to a differential reduction in inpatient stays of 63 (95% CI, 10-116) per thousand members per year. Medicare Advantage was associated with a differential reduction in total spending (Parts A and B) of $142 (95% CI, $0-$282) per member per month, which was 36% of total spending in TM. There was no differential reduction in professional (Part B) spending (per member per month, $47; 95% CI, $51-$145) or utilization.Conclusions and relevanceIn this cohort study with a difference-in-differences analysis, during the first year of Medicare coverage, MA was associated with large reductions in institutional (Part A) utilization and spending.
| S-EPMC8796939 | biostudies-literature
Project description:ObjectivesTo compare use of diabetes medications between beneficiaries enrolled in Medicare Advantage (MA) and traditional Medicare (TM).Study designRetrospective cohort analysis of Medicare enrollment and Part D event claims during 2015-2016.MethodsData came from 1,027,884 TM and 838,420 MA beneficiaries who received at least 1 prescription for an oral or injectable diabetes medication. After matching MA and TM enrollees by demographic characteristics and geography, we analyzed use of medication overall, choices of first diabetes medication for those new to medication, and patterns of adding medications.ResultsOverall and for patients on 1, 2, or 3 diabetes medications, use of metformin was higher in MA by about 3 percentage points, but use of newer medication classes was 5.1 percentage points higher in TM overall (21.3% vs 16.2%). Use of guideline-recommended first-line agents was higher in MA. For those who started metformin first, use of a sulfonylurea as a second medication was 7.8 percentage points higher in MA than TM (61.5% vs 53.7%), whereas use of medications from newer classes was 7.7 percentage points lower (22.0% vs 29.7%). Mean total spending was $149 higher in TM for those taking 1 medication and $298 higher for those taking 2 medications. Differences in spending among MA plans were of similar magnitude to the MA-TM differences.ConclusionsMA enrollees are more likely to be treated with metformin and sulfonylureas and less likely to receive costly newer medications than those in TM, but there also is substantial variation within MA. A limitation of the study is that we could not assess glucose control using glycated hemoglobin levels.
| S-EPMC7967940 | biostudies-literature
Project description:ObjectivesPrior analyses of Medicare health plans have examined either utilization of services or quality of care, but not both jointly. Our objective was to compare utilization and quality for Medicare Advantage (MA) enrollees with diabetes or cardiovascular disease to that for similarly defined traditional Medicare (TM) beneficiaries.Study designCross-sectional matched observational study using data for 2007.MethodsWe obtained individual-level Healthcare Effectiveness Data and Information Set (HEDIS) relative resource use (RRU) and quality data for patients enrolled in MA, and then developed comparable claims-based measures for matched samples of TM beneficiaries.Main outcome measuresutilization levels for inpatient care, evaluation and management services, and surgery; number of emergency department (ED) and inpatient visits; and quality of ambulatory care measures.ResultsWe studied approximately 680,000 MA health maintenance organization (HMO) enrollees with diabetes and 270,000 HMO enrollees with cardiovascular conditions. For both conditions and almost all major strata, the RRU was lower for those enrolled in MA than for those in TM. Spending for those with diabetes was $5223 for MA HMO enrollees compared with $6413 for those in TM (cost ratio, 0.81; P < .001). ED utilization rates were consistently lower in MA than TM (567 vs 719 visits/1000 enrollees; rate ratio, 0.79; P < .001). Health plans that are more established, nonprofit, and/or larger generally had lower resource use and better relative quality than did smaller, newer, for-profit HMOs or preferred provider organizations.ConclusionsRRU for those with diabetes or cardiovascular disease is lower in MA, while quality of care is higher. Better MA plans may add value to the care of these major chronic medical conditions.
| S-EPMC6365159 | biostudies-literature
Project description:Enrollment in Medicare Advantage, the managed care program for Medicare beneficiaries, has grown rapidly, from 4.6 million enrollees in 2003 to 12.8 million by 2012, or 27 percent of all current Medicare beneficiaries. We analyzed utilization patterns of enrollees in Medicare Advantage health maintenance organization (HMO) plans compared to matched samples of people in traditional Medicare during 2003-09, to ascertain whether the HMO enrollees demonstrated different levels of use of services, which can be a hallmark of more integrated care. We found that utilization rates in some major categories, including emergency departments and ambulatory surgery or procedures, generally were 20-30 percent lower in Medicare Advantage HMOs in all years. Medicare Advantage HMO enrollees initially had lower rates of ambulatory visits and hospitalizations, although these rates converged by 2008; they also received about 10 percent fewer hip or knee replacements. In contrast, HMO enrollees underwent more coronary bypass surgery than patients in traditional Medicare. These findings suggest that overall, Medicare Advantage HMO enrollees might use fewer services and be experiencing more appropriate use of services than enrollees in traditional Medicare.
| S-EPMC3587962 | biostudies-literature