Medicare Advantage Plan and Health System Vertical Integration, 2011-2020.
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ABSTRACT:
SUBMITTER: Bejarano G
PROVIDER: S-EPMC11259896 | biostudies-literature | 2024 Jul
REPOSITORIES: biostudies-literature
Publications
Medicare Advantage Plan and Health System Vertical Integration, 2011-2020.
Bejarano Geronimo G Ryan Andrew A Trivedi Amal A Offiaeli Kendra K Meyers David J DJ
JAMA network open 20240701 7
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Project description:ImportanceMedicare Advantage (MA) beneficiaries are increasingly enrolling in integrated MA plans. Legacy-integrated plans share unique features that may differ from newer integrated MA plans. It is unclear whether integrated and legacy-integrated MA plans are associated with a better beneficiary care experience compared with non-legacy-integrated and nonintegrated MA plans.ObjectiveTo assess whether enrollment in integrated, legacy-integrated, non-legacy-integrated, and nonintegrated MA plans is associated with better beneficiary care experiences.Design, setting, and participantsThis cross-sectional study included MA beneficiaries who responded to Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys conducted annually between 2015 and 2019. Data analysis was performed between October 1, 2023, and July 31, 2024.ExposureMedicare Advantage plan integration status, categorized as integrated, legacy-integrated, non-legacy-integrated, and nonintegrated.Main outcomes and measuresThe CAHPS surveys assessed 9 care experience measures. To assess differences in care experience measures, mixed linear regression analyses were performed, adjusting for demographic characteristics, plan random effects, and state fixed effects.ResultsThe sample consisted of 857 695 respondents. Their mean (SD) age was 72.6 (10.3) years, and 58.1% were women. A total of 12.7% of respondents were Black, 10.7% were Hispanic, and 71.0% were White. Compared with respondents in nonintegrated MA plans, respondents in integrated MA plans were younger (mean [SD] age, 72.7 [10.3] vs 72.2 [10.3] years, respectively) and were less likely to be Black (13.1% vs 11.2%, respectively), female (58.4% vs 57.2%, respectively), and partially dual eligible (8.7% vs 6.2%, respectively). Integrated MA plans were associated with meaningfully better mean ratings only of customer service (1.6 points [95% CI, 1.1-2.1]) and health plan (1.0 points [95% CI, 0.6-1.5]) compared with nonintegrated MA plans. Legacy-integrated MA plans were associated with meaningfully better mean ratings of drug plan (3.7 points [95% CI, 2.4-5.0]), health plan (3.1 points [95% CI, 1.7-4.5]), customer service (2.8 points [95% CI, 1.3-4.4]), getting appointments and care quickly (2.6 points [95% CI, 1.2-4.0]), health care quality (1.9 points [95% CI, 1.0-2.7]), physicians who communicate well (1.1 points [95% CI, 0.4-1.8]), and care coordination (1.1 points [95% CI, 0.4-1.9]) compared with nonintegrated MA plans.Conclusions and relevanceIn this study, integrated MA plans were not associated with better beneficiary care experiences compared with nonintegrated MA plans. Legacy-integrated MA plans were associated with higher ratings on all care experience measures compared with both non-legacy-integrated and nonintegrated MA plans. Monitoring of integrated MA plans is needed to assess whether they are adding meaningful value to MA beneficiaries and to determine their effects on the health care system.
| S-EPMC11581604 | biostudies-literature
Project description:ObjectiveTo investigate how integration between Medicare Advantage plans and health care providers is related to plan premiums and quality ratings.Data sourceWe used public data from the Centers for Medicare and Medicaid Services (CMS) and the Area Resource File and private data from one large insurer. Premiums and quality ratings are from 2009 CMS administrative files and some control variables are historical.Study designWe estimated ordinary least-squares models for premiums and plan quality ratings, with state fixed effects and firm random effects. The key independent variable was an indicator of plan-provider integration.Data collectionWith the exception of Medigap premium data, all data were publicly available. We ascertained plan-provider integration through examination of plans' websites and governance documents.Principal findingsWe found that integrated plan-providers charge higher premiums, controlling for quality. Such plans also have higher quality ratings. We found no evidence that integration is associated with more generous benefits.ConclusionsCurrent policy encourages plan-provider integration, although potential effects on health insurance products and markets are uncertain. Policy makers and regulators may want to closely monitor changes in premiums and quality after integration and consider whether quality improvement (if any) justifies premium increases (if they occur).
| S-EPMC3876399 | biostudies-literature
Project description:ImportanceThe Medicare Advantage (MA) program is rapidly growing. While previous work has found that beneficiaries with substantial health needs disenroll from plans at higher rates, the long-term frequency of disenrollment is not well understood.ObjectiveTo compare cumulative disenrollment trends in the MA program by beneficiary and plan characteristics.Design, setting, and participantsThis retrospective, serial cross-sectional study included beneficiaries with any MA enrollment from January 1, 2011, to December 31, 2020. Data analysis took place from September 2022 to March 2023.ExposuresBeneficiary characteristics, including race and ethnicity, length of Medicare enrollment, dual eligibility, and comorbidity burden, and contract characteristics, including vertical integration status, premium, and MA star rating.Main outcomes and measuresThe main outcome was disenrollment from an MA contract within 5 years. Rates of cumulative disenrollment by beneficiary and contract characteristics were compared. Pearson correlation coefficients were calculated to assess the correlation between a contract's 1-year disenrollment and the contract's disenrollment over a longer period.ResultsThe sample included 82 377 917 beneficiaries (524 442 225 beneficiary-year observations; 56.7% female; mean [SD] age, 71.9 [10.3] years). After 1 year, 13.2% of nondually enrolled and 15.9% of dually enrolled beneficiaries had left their contract, increasing to 48.3% and 53.4%, respectively, after 5 years. Black enrollees disenrolled at the highest rates among race and ethnicity categories, with 14.8% disenrolling after 1 year and 52.6% disenrolling after 5 years. Contracts had a median disenrollment rate of 9.8% (IQR, 4.5%-19.0%) after 1 year and 56.1% (IQR, 23.1%-79.0%) after 5 years. Contracts rated 5 stars had substantially lower 5-year disenrollment rates (23.0% after 5 years compared with 41.2% for 4- to 4.5-star contracts and 67.2% for 3- to 3.5-star contracts). Disenrollment from a contract after 1 year was not well correlated with disenrollment after 5 years (r, 0.46).Conclusions and relevanceThis cross-sectional study found substantial cumulative rates of disenrollment from MA plans within 5 years between 2011 and 2020, with wide variation in 5-year disenrollment by contract. The findings suggest that evaluating long-term disenrollment rates in MA performance measures may capture different outcomes than single-year disenrollment alone.
| S-EPMC10457718 | biostudies-literature
Project description:ImportanceHealth insurance literacy helps individuals make informed choices. However, evidence suggests that Medicare beneficiaries experience low health insurance literacy, leading to high-cost or poor-quality coverage choices.ObjectiveTo examine how health insurance literacy was associated with coverage choices between traditional Medicare (TM) and Medicare Advantage (MA), as well as within MA.Design, setting, and participantsThis cross-sectional study included 6627 TM and MA enrollees, using data from the 2015-2016 Medicare Current Beneficiary Survey. Data analyses were conducted between May 1 and June 30, 2021.ExposuresThree self-reported measures of health insurance literacy (presence of information to make an informed comparison, ease in reviewing and comparing coverage options, and annual review and comparison of coverage options).Main outcomes and measuresEnrollment in TM vs MA and enrollment in an MA plan with different characteristics (star rating, monthly plan premium, in-network maximum out-of-pocket limit, plan type, and provision of supplemental benefits).ResultsWe included 6627 Medicare beneficiaries (3578 women [54.0%]; mean [SD] age, 75.13 [7.12] years). A total of 77 individuals were Asian (1.2%), 696 were Black (10.5%), 488 were Hispanic (7.4%), 5277 were non-Hispanic White (79.6%), and 225 (3.4%) were single races not of Hispanic origin (including American Indian or Alaska Native and Native Hawaiian) or were 2 or more races. Medicare Advantage enrollment was higher among individuals with higher health insurance literacy than those with lower health insurance literacy, especially for those who reviewed or compared coverage options annually than among those who did not (38.0%; 95% CI, 36.0%-40.1% vs 27.8%; 95% CI, 25.8%-29.7%). Among MA beneficiaries, those who reviewed or compared coverage options annually were more likely to enroll in plans with 4 to 4.5 stars and plans with monthly premiums of $1 to $50 by 4.6 percentage points (95% CI, 0.1-9.2 percentage points) and 4.8 percentage points (95% CI, 0.6-9.0 percentage points), respectively. However, enrollment in plans with 5 stars was 3.8 percentage points lower (95% CI, -5.8 to -1.9 percentage points) among individuals who reviewed or compared coverage options annually than among those who did not. Among individuals with low socioeconomic status, the likelihood of reviewing or comparing coverage options annually was lower for those with Medicare and Medicaid dual eligibility than for those without it (odds ratio, 0.79; 95% CI, 0.63-0.99).Conclusions and relevanceResults of this study suggest that higher health insurance literacy-particularly, annual review and comparison of coverage choices-is associated with higher MA enrollment and choice of a particular MA plan. Policy makers should develop programs to encourage frequent review and comparison of coverage options for informed decision making.
| S-EPMC8814909 | biostudies-literature
Project description:ObjectiveTo examine the relationship between insurer market structure, health plan quality, and health insurance premiums in the Medicare Advantage (MA) program.Data sources/study settingAdministrative data files from the Centers for Medicare and Medicaid Services, along with other secondary data sources.Study designTrends in MA market concentration from 2008 to 2017 are presented, alongside logistic and linear regression models examining MA plan quality and premiums as a function of insurer market structure for 2011.Data collection/extraction methodsData are publicly available.Principal findingsMA plans that tend to operate in more concentrated MA markets have a higher predicted probability of receiving a high-quality health plan rating. Operating in more concentrated MA markets was also found to be associated with higher premiums. Among plans that tend to operate in very concentrated MA markets, high-quality MA plans were associated with premiums as much as two times higher than premiums associated with lower-quality plans.ConclusionsAny policies directed at enhancing insurer competition should consider implications for health plan quality, which may be very different than the implications for enrollee premiums.
| S-EPMC6736911 | biostudies-literature
Project description:Approximately 34% of all Medicare beneficiaries were enrolled in a Medicare Advantage (MA) plan in 2019. Quantitative evidence suggests that MA beneficiaries have low rates of switching plans, but that beneficiaries who are hospitalized or use postacute nursing home care are disproportionately more likely to exit their plan. This research sought to explore how MA enrollees choose plans and the factors involved in their decision to keep their current plan or switch plans. We conducted 25 semistructured interviews focusing on expectations and experiences preenrollment and postenrollment among MA beneficiaries. Overall, the beneficiaries interviewed reported being highly satisfied with their plans. After selecting a plan, there was little incentive to revisit their choice since they viewed their plan as "good enough." Confusion, health status, cost and benefits also contributed to many seniors keeping or switching their plans. These seniors were reluctant to switch plans unless they experienced a major health event.
| S-EPMC7903586 | biostudies-literature
Project description:ImportanceMedicare Advantage (MA) has grown in popularity, but critics believe that insurers are overpaid, partially due to the quartile adjustment system that determines plan benchmarks. However, elimination of the quartile adjustments may be associated with less generous benefits and fewer plan offerings, which could slow MA enrollment growth.ObjectiveTo examine whether the quartile adjustment system is associated with differences in county-level benefits, insurer offerings, and MA enrollment.Design, setting, and participantsThe quartile adjustments create discontinuous jumps in county-level base payments based on historical traditional Medicare spending. Data from January 2017 to December 2021 and a regression discontinuity design were used to examine changes in insurer behavior and MA enrollment between quartiles. The analytic sample included 1557 county observations.Main outcomes and measuresStudy outcomes included monthly premiums, the share of plans charging premiums, primary care copayments, the share of plans using rebates to reduce Part B premiums, supplemental benefits, plan and contract availability, and MA enrollment.ResultsDiscontinuities were found in the quartile adjustments and benchmarks. A 1-percentage point (pp) increase in the quartile adjustment was associated with a $6.36 increase in monthly benchmarks (95% CI, 5.10-7.62), a $0.51 decrease in monthly premiums (95% CI, -0.96 to -0.07), and a 0.68 pp decrease in the share of plans charging premiums (95% CI, -1.25 to -0.10). Significant changes were not found in primary care copayments (-$0.04; 95% CI, -0.17 to 0.09), the share of plans using rebates to reduce Part B premiums (-0.17 pp; 95% CI, -0.34 to 0.01), supplemental benefits (eg, preventive dental coverage; 0.17 pp; 95% CI, -0.25 to 0.0), the number of plans (1.06; 95% CI, -3.44 to 5.57) or contracts (0.31; 95% CI, -0.18 to 0.81), or the MA enrollment rate (0.16 pp; 95% CI, -0.61 to 0.94).Conclusions and relevanceThe study results suggest that MA plans are not very sensitive to modest changes in payment rates. Modifications to the quartile adjustment system may generate savings without substantially affecting MA beneficiaries.
| S-EPMC10787313 | biostudies-literature
Project description:ImportanceVarious policy proposals would reduce federal payments to Medicare Advantage (MA) plans. However, it is unclear whether payment reductions would compromise beneficiary access to the MA program.ObjectiveTo quantify the association between MA payment reductions under the Affordable Care Act (ACA) and MA enrollment growth.Design, setting, and participantsThis retrospective cohort study examined the MA market before and after the ACA, which mandated cuts to MA benchmark payment rates. Using 2008 to 2019 county-level enrollment and payment data, a difference-in-differences analysis was conducted comparing MA enrollment changes between counties with larger vs smaller benchmark reductions, before vs after the ACA.Main outcomes and measuresThe primary outcome was the MA enrollment rate, defined as the proportion of a county's Medicare beneficiaries enrolled in MA. A secondary analysis examined MA plan payments per member per month.ResultsAmong 3138 counties with 37 639 county-year observations, ACA-induced benchmark cuts were sizeable and varied, ranging from 0% to 42.9% (mean [SD], 5.9% [6.6%]). Counties with benchmark cuts above the 75th percentile had population-weighted average benchmark cuts of 14.9% compared with 4.4% in other counties. In the 8 years following the ACA, there was no differential change in MA enrollment between counties with larger vs smaller benchmark cuts (difference-in-differences estimate, 0.02 [95% CI, -1.18 to 1.21] percentage points; P = .98). Plan payments differentially fell in counties with larger benchmark cuts by $78.35 (95% CI, $62.21-$94.48) per member per month (P < .001).Conclusion and relevanceThis cohort study found no evidence that the MA benchmark and ensuing payment cuts imposed by the ACA were associated with reduced MA enrollment, compromising access to MA. This evidence can inform ongoing policy debates regarding the growth of MA, concerns about excess payments to MA plans, and proposed Medicare reforms, including further reductions in MA payments.
| S-EPMC10290750 | biostudies-literature
Project description:BackgroundIdiopathic pulmonary fibrosis (IPF) is a rare life-threating interstitial lung disease (ILD). This study characterizes demographics, health care utilization, and comorbidities among elderly IPF patients and estimates prevalence and incidence rates for selected outcomes.MethodsCohort study using a large US health insurance database (Optum's Medicare Advantage plan).Inclusion criteria≥ 1 diagnosis code for IPF (2008 - 2014), age ≥65 years, no diagnosis of IPF or other ILD in prior 12 months. Demographics, health care utilization, comorbidities and incidence rates for various outcomes were estimated. Follow-up continued until the earliest of: health plan disenrollment, death, a claim for another known cause of ILD, or end of the study period.Results4,716 patients were eligible; 53.4% had IPF diagnostic testing. Median age was 77.5 years, 50.3% were male, median follow-up time was 0.8 years. Incidence rates ranged from 1.0/1,000 person-years (lung transplantation) to 374.3/1,000 person-years (arterial hypertension). Baseline characteristics and incidence rates were similar for cohorts of patients with and without IPF diagnostic testing.ConclusionsElderly IPF patients experience a variety of comorbidities before and after IPF diagnosis. Therapies for IPF and for the associated comorbidities may reduce morbidity and associated health care utilization of these patients.
| S-EPMC6327584 | biostudies-literature
Project description:This cross-sectional study examines the extent of narrow networks across Medicare Advantage, types of counties where they are common, enrollment in narrow network plans, and how networks are associated with star ratings.
| S-EPMC8796886 | biostudies-literature