Association Between Medicare Advantage Plan Star Ratings and Enrollment

Reid, Rachel O.; Deb, Partha; Howell, Benjamin L.; Shrank, William H.

doi:10.1001/jama.2012.173925

Cited by 90 publications

(87 citation statements)

References 19 publications

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“…Studies in the commercial market demonstrate associations between preferences and plans' costs, benefits, and quality, 7,16 and prior work demonstrates associations between Medicare Advantage star ratings and enrollment. 17 However, the relative importance of cost and quality in Medicare Advantage choices is unknown.…”

Section: Introductionmentioning

confidence: 99%

The Roles of Cost and Quality Information in Medicare Advantage Plan Enrollment Decisions: an Observational Study

et al. 2015

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BACKGROUND:To facilitate informed decision-making in the Medicare Advantage marketplace, the Centers for Medicare & Medicaid Services publishes plan information on the Medicare Plan Finder website, including costs, benefits, and star ratings reflecting quality. Little is known about how beneficiaries weigh costs versus quality in enrollment decisions. OBJECTIVE: We aimed to assess associations between publicly reported Medicare Advantage plan attributes (i.e., costs, quality, and benefits) and brand market share and beneficiaries' enrollment decisions. DESIGN, SETTING, PARTICIPANTS: We performed a nationwide, beneficiary-level cross-sectional analysis of 847,069 beneficiaries enrolling in Medicare Advantage for the first time in 2011. MAIN MEASURES: Matching beneficiaries with their plan choice sets, we used conditional logistic regression to estimate associations between plan attributes and enrollment to assess the proportion of enrollment variation explained by plan attributes and willingness to pay for quality. KEY RESULTS: Relative to the total variation explained by the model, the variation in plan choice explained by premiums (25.7 %) and out-of-pocket costs (11.6 %) together explained nearly three times as much as quality ratings (13.6 %), but brand market share explained the most variation (35.3 %). Further, while beneficiaries were willing to pay more in total annual combined premiums and out-of-pocket costs for higher-rated plans (from $4,154.93 for 2.5-star plans to $5,698.66 for 5-star plans), increases in willingness to pay diminished at higher ratings, from $549.27 (95 %CI: $541.10, $557.44) for a rating increase from 2.5 to 3 stars to $68.22 (95 %CI: $61.44, $75.01) for an increase from 4.5 to 5 stars. Willingness to pay varied among subgroups: beneficiaries aged 64-65 years were more willing to pay for higherrated plans, while black and rural beneficiaries were less willing to pay for higher-rated plans. CONCLUSIONS: While beneficiaries prefer higher-quality and lower-cost Medicare Advantage plans, marginal utility for quality diminishes at higher star ratings, and their decisions are strongly associated with plans' brand market share.

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Section: Introductionmentioning

confidence: 99%

The Roles of Cost and Quality Information in Medicare Advantage Plan Enrollment Decisions: an Observational Study

et al. 2015

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“…Five star plans are additionally rewarded with the opportunity to enroll plan members all yearlong versus a 6 week time period beginning in October. Recent research suggests that higher star ratings are also associated with an increased likelihood that first-time enrollees will select that plan [41].…”

Section: Discussionmentioning

confidence: 99%

Nurse Practitioners in Physician Practices: Implications for Member Satisfaction

Guerard¹,

Omachonu²,

Harvey³

et al. 2016

J Hosp Med Manage

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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.

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“…A recent study evaluating the association between star ratings and enrollment decisions quantified the average value of increased ratings. Reid et al (2013) found that an increase in 1 star was associated with a 9.5% increased likelihood to enroll new enrollees. 21 Among members switching plans, for every 1-star increase there was a 4.4% increased likelihood to enroll.…”

Section: Figurementioning

confidence: 97%

“…Reid et al (2013) found that an increase in 1 star was associated with a 9.5% increased likelihood to enroll new enrollees. 21 Among members switching plans, for every 1-star increase there was a 4.4% increased likelihood to enroll. For MA-PD plans with consecutive low star ratings, increases in performance ratings will prevent a "Low Performing Icon" (LPI).…”

Section: Figurementioning

confidence: 97%

Evaluation of an Integrated Adherence Program Aimed to Increase Medicare Part D Star Rating Measures

Leslie¹,

Tirado²,

Patel³

et al. 2014

JMCP

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Association Between Medicare Advantage Plan Star Ratings and Enrollment

Abstract: Medicare's 5-star rating program for Medicare Advantage is associated with beneficiaries' enrollment decisions.

Cited by 90 publications

References 19 publications

The Roles of Cost and Quality Information in Medicare Advantage Plan Enrollment Decisions: an Observational Study

The Roles of Cost and Quality Information in Medicare Advantage Plan Enrollment Decisions: an Observational Study

Nurse Practitioners in Physician Practices: Implications for Member Satisfaction

Evaluation of an Integrated Adherence Program Aimed to Increase Medicare Part D Star Rating Measures

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