Self-reported number of chronic conditions and prescription medications are not in high concordance with claims data. Health care researchers and policy makers using patient self-reported data should be aware of these potential biases.

Self-reported changes in physical and mental health by members are an important dimension by which the quality of a Medicare Advantage (MA) plan is rated by the Centers for Medicare & Medicaid Services. To better target their interventions, MA plans need a better understanding of what observed characteristics-including clinical health conditions-predict self-reported changes in physical and mental health. This study explored how one MA plan's survey of participants' responses regarding changes in physical and mental health is associated with a set of chronic conditions as well as sociodemographic characteristics. Multinomial logistic regressions were used to examine the influence of 9 chronic conditions and age, sex, race, education, dual eligibility status (Medicare/Medicaid eligible), marital and living status, and assistance with survey completion on changes in patient-reported physical and mental health. Six conditions-dementia (P < 0.001), diabetes (P = 0.003), congestive heart failure (P = 0.002), cerebrovascular disease (P = 0.001), coronary artery disease (CAD) (P < 0.001), and rheumatoid arthritis (P < 0.001)-were associated with self-reported worsening of overall physical health. Four conditions-dementia (P < 0.002), diabetes (P = 0.047), CAD (P = 0.001), and decubitus ulcers (P = 0.033)-were associated with self-reported worsening of overall mental health. Females, married respondents, and those needing assistance with survey completion were more likely to report worsening of their mental health. Enrollees older than age 65 actually were less likely to report worsening of overall mental health. Findings provide insight into which members may be more susceptible to reporting that their physical or mental health is worsening.

The issue of medication nonadherence has generated significant interest because of its complexity from both cost and outcomes perspectives. Of the 3.2 billion prescriptions written annually in the United States, estimates indicate that half are not taken as prescribed, especially among patients with asymptomatic chronic conditions. The objective of this study was to assess whether a comprehensive wellness assessment (CWA) program helps improve medication adherence for oral diabetic medications, statins, and angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (ACE/ARBs) in a Medicare Advantage (MA) plan diabetic population. The Centers for Medicare & Medicaid Services includes these medications among its triple-weighted measures.The researchers used a retrospective panel study employing administrative claims data and member month-level enrollment data for members who were newly diagnosed with diabetes since 2010, allowing for up to 5 years of follow-up. The treatment variable of interest was whether the enrollee had undergone a CWA in the 12 months prior to the study. Results for the full sample show that a CWA visit in the prior 12 months is significantly associated with increased adherence to statin medication (incidence rate ratio [IRR]: 1.022, t-test: 2.51) and oral diabetes medication (IRR: 1.032, t-test: 3.00), but it is not significantly associated with adherence to ACE/ARB medication (IRR: 1.009, t-test: 1.09). Results vary considerably in subsamples stratified by dual Medicare and Medicaid eligibility status, presence of certain chronic conditions, and age. CWAs are most beneficial when targeted toward dual-eligible members or members younger than 65. On the basis of these findings, improving medication adherence by targeting CWA visits to certain MA member subcategories may be more cost-effective than using CWAs for the full MA membership.

Medication adherence is often lower among disadvantaged patients. Drivers of medication adherence may include the quality of communications between patient and medical caregiver. The research objective is to assess whether an annual Comprehensive Wellness Assessment (CWA) is associated with improved medication adherence. The CWA targeted primarily dual eligible Special Needs Plan (SNP) enrollees in a Medicare Advantage plan. This retrospective panel study used administrative claims data and member-month level data for members who were newly diagnosed with diabetes in 2010, allowing for up to 5 years of follow-up. The intervention of interest is whether the member received a CWA in the past 12 months. Multivariate regression models were estimated using pooled member-month data and a difference-in-difference type approach to assess whether CWA visits improve oral diabetes medication (ODM) adherence among SNP enrollees. Twenty-six percent of pooled member-month observations are from SNP enrollees. Average monthly ODM adherence is 77.5%. Approximately 31% of SNP enrollees had a CWA in the last 12 months, compared to 5% of regular enrollees. Regression results show SNP enrollees with a CWA on average had higher monthly adherence by 3.9 percentage points (P < 0.01), and were 7% more likely to meet the threshold of at least 80% adherence (P < 0.01). Adherence is even higher for the subsample of African American SNP enrollees with CWA. CWA appears to be effective in improving ODM adherence among SNP patients. Care models with components like wellness assessments that include medication review and education may improve medication adherence as well as Medicare Advantage plan star ratings.

Background: There is limited information about how Nurse Practitioners can affect patient satisfaction among elderly patients. This study considered the implications of assigning in-office Medicare Advantage (MA) plan Nurse Practitioners (NPs) in Primary Care Physician (PCP) practices which were affiliated with the (MA) plan. Specifically, this was a baseline study that explored whether the presence of an NP in the PCP practice was associated with improved satisfaction of members of the MA plan with their PCP, and whether member satisfaction with their PCP was associated with satisfaction with the MA plan.Methods: Self-reported, cross-sectional data previously collected by the MA organization from enrollees was linked to data on participating PCPs. Twentytwo percent of responding members had a PCP with an NP in the practice. Multivariate logistic regression models were estimated to find the association between presence of in-office NPs and a 'high' member rating of the PCP, and the association between 'high' rating of PCP and 'high' rating of MA plan. Findings:PCPs with in-office NPs were four percentage-points more likely to be rated highly by members (OR: 1.37, p<0.05, 95% CI: 1.06-1.78) than those without NPs. Members who rated PCPs highly were also 24 percentage-points more likely to give the MA plan a high rating (OR: 6.58, p<0.01, 95% CI: 5.64-7.35) than members who did not. Conclusion:These associative relationships support an intervention where the MA plan has started placing NPs in PCP practices. Follow-up analyses will help ascertain whether embedding NPs had a causal impact on improving patient satisfaction.