Comparison of Medicare Advantage vs Traditional Medicare for Health Care Access, Affordability, and Use of Preventive Services Among Adults With Low Income

Aggarwal, Rahul; Gondi, Suhas; Wadhera, Rishi K.

doi:10.1001/jamanetworkopen.2022.15227

Cited by 14 publications

(8 citation statements)

References 23 publications

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“…When Medicare Advantage was launched in 2003, agencies expected improved affordability and widened coverage as the program provided protection from extreme out-ofpocket expenses and added supplemental benefits. Previous studies on Medicare Advantage have demonstrated reduced expenses but have varied results regarding health quality, access, and outcomes [10,[12][13][14]16,17]. In our study, we noted a lack of improvement in utility and accessibility among Medicare Advantage plans for cancer survivors, which raises important questions about the value and cost-effectiveness of the extra benefits offered to beneficiaries.…”

Section: Discussionmentioning

confidence: 58%

“…Most Medicare Advantage plans are funded by risk-adjusted, fixed, per-person payments for beneficiaries, which creates an incentive to be cost effective when delivering care. While this incentive could lead to a larger emphasis on value-based and preventative care, it could also lead to the rationing of healthcare resources and possible avoidance of necessary care [10]. Further, Medicare Advantage plans can be a valuable tool for managing the high costs of cancer treatment, but may include more restrictions on the providers and services that are covered, and may require higher premiums than traditional Medicare does [11].…”

Section: Introductionmentioning

confidence: 99%

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Association of Medicare Program Type with Health Care Access, Utilization, and Affordability among Cancer Survivors

Jafri

Patel

et al. 2023

Cancers

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Background: The Medicare Advantage program provides care to nearly half of Medicare beneficiaries, including a rapidly growing population of cancer survivors. Despite its increased adoption, it is still unknown whether or not the program improves healthcare access, outcomes, and affordability for cancer survivors. Methods: We performed a cross-sectional study of Medicare beneficiaries aged ≥ 65 years with a self-reported history of cancer from the 2019 National Health Interview Survey. We used multivariable logistic regression to evaluate the association between Medicare program type (Medicare Advantage vs. traditional Medicare) and measures of healthcare access, acute care utilization, and affordability. Results: We identified 4451 beneficiaries with a history of cancer, corresponding to 26.6 million weighted cancer survivors in 2019. Of the beneficiaries, 35.8% were enrolled in Medicare Advantage, whereas 64.2% were enrolled in traditional Medicare. The age, sex, racial and ethnic composition, household income, primary site of cancer, and comorbidity burden of Medicare Advantage and traditional Medicare beneficiaries were similar. In the adjusted analysis, there were no differences in healthcare access or acute care utilization between traditional Medicare and Medicare Advantage beneficiaries. However, cancer survivors enrolled in Medicare Advantage were more likely to worry about (34.3% vs. 29.4%; aOR, 1.3 (95% CI, 1.1–1.5)) or have problems paying (13.6% vs. 11.1%; aOR, 1.4 (95% CI, 1.1–1.8)) medical bills. Conclusions: We found no evidence that Medicare Advantage beneficiaries with cancer had better healthcare access, affordability, or acute care utilization than traditional Medicare beneficiaries did. Furthermore, Medicare Advantage beneficiaries were more likely to report financial strain and have difficulty paying for their medical bills than were those with traditional Medicare. Despite the generous benefits and attractive incentives, Medicare Advantage plans may not be more cost-effective than traditional Medicare is for cancer survivors. Our study informs ongoing congressional deliberations to re-evaluate the role of Medicare Advantage in promoting equity among beneficiaries with cancer.

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Section: Discussionmentioning

confidence: 58%

Section: Introductionmentioning

confidence: 99%

Association of Medicare Program Type with Health Care Access, Utilization, and Affordability among Cancer Survivors

Jafri

Patel

et al. 2023

Cancers

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“…Furthermore, this study cannot reliably assess which hospitalizations were necessary vs potentially wasteful, nor which encounters were appropriately triaged to observation status or directly treated and discharged from the ED. Other work has found that Medicare Advantage is no different nor does it outperform traditional Medicare when focused on other elements of quality (eg, measures of ambulatory care) and narrow subpopulations. Yet the active use of ACSCs by policy makers to assess Medicare Advantage quality (eg, star ratings) creates incentives for plans to reduce ACSCs, thereby making it important to study these measures.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Potentially Avoidable Acute Care Utilization Among Patients Insured by Medicare Advantage vs Traditional Medicare

et al. 2023

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ImportanceMedicare Advantage plans have strong incentives to reduce potentially wasteful health care, including costly acute care visits for ambulatory care−sensitive conditions (ACSCs). However, it remains unknown whether Medicare Advantage plans lower acute care use compared with traditional Medicare, or if it shifts patients from hospitalization to observation stays and emergency department (ED) direct discharges.ObjectiveTo determine whether Medicare Advantage is associated with differential utilization of hospitalizations, observations, and ED direct discharges for ACSCs compared with traditional Medicare.Design, Setting, and ParticipantsCross-sectional study of US Medicare Advantage vs traditional Medicare beneficiaries from January 1 to December 31, 2018. Poisson regression models were used to compare risk-adjusted rates of Medicare Advantage vs traditional Medicare, controlling for patient demographic characteristics and clinical risk and including county fixed-effects. Data were analyzed between April 2021 and November 2022.Main Outcomes and MeasuresHospitalizations, observation stays, and ED direct discharges for ACSCs.ResultsThe study sample comprised 2 665 340 Medicare Advantage patients (mean [SD] age, 72.7 [9.8] years; 1 504 519 [56.4%] women; 1 859 067 [69.7%] White individuals) and 7 981 547 traditional Medicare patients (mean [SD] age, 71.2 [11.8] years; 4 232 201 [53.0%] women; 6 176 239 [77.4%] White individuals). Medicare Advantage patients had lower risk of hospitalization for ACSCs compared with traditional Medicare patients (relative risk [RR], 0.94; 95% CI, 0.93-0.95), primarily owing to fewer hospitalizations for acute conditions (eg, pneumonia). Medicare Advantage patients had a higher risk of ED direct discharges (RR, 1.44; 95% CI, 1.43-1.45) and observation stays (RR, 2.38; 95% CI, 2.34-2.41) for ACSCs vs traditional Medicare patients. Overall, Medicare Advantage patients were at higher risk of needing care for an ACSC (hospitalization, ED direct discharge, or observation stay) than traditional Medicare patients (RR, 1.30; 95% CI, 1.30-1.31). Within the Medicare Advantage population, patients in health maintenance organizations (HMOs) were at lower risk of ACSC-related hospitalization compared with patients in its preferred provider organizations (RR, 0.96; 95% CI, 0.95-0.98); however, those in the HMOs had a higher risk of ED direct discharge (RR, 1.08; 95% CI, 1.07-1.09) and observation stay (overall RR, 1.10; 95% CI, 1.02-1.12).Conclusions and RelevanceThe findings of this cross-sectional study of Medicare Advantage and traditional Medicare patients with ACSCs indicate that apparent gains in lowering rates of potentially avoidable acute care have been associated with shifting inpatient care to settings such as ED direct discharges and observation stays.

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“…However, it is ambiguous whether networks would reduce the number of unique PCPs seen by beneficiaries. Indeed, there is evidence MA‐PD beneficiaries may actually see more unique PCPs than those in PDPs 17 . Thus, for PCPs, the O/E ratio may be greater than 1 (Appendix A1).…”

Section: Study Data and Methodsmentioning

confidence: 99%

“…Indeed, there is evidence MA-PD beneficiaries may actually see more unique PCPs than those in PDPs. 17 Thus, for PCPs, the O/E ratio may be greater than 1 (Appendix A1).…”

Section: Conceptual Frameworkmentioning

confidence: 99%

Measuring restrictiveness of Medicare Advantage networks: A claims‐based approach

Feyman,

Pizer,

Shafer

et al. 2023

Health Services Research

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ObjectiveTo develop and validate a measure of provider network restrictiveness in the Medicare Advantage (MA) population.Data SourcesPrescription drug event data and beneficiary information for Part D enrollees from the Center for Medicare and Medicaid Services, along with prescriber identifiers; geographic variables from the Area Health Resources Files.Study DesignA prediction model was used to predict the unique number of primary care providers that would have been seen by MA beneficiaries absent network restrictions. The model was trained and validated on Traditional Medicare (TM) beneficiaries. A pseudo‐Poisson and a random forest model were evaluated. An observed‐to‐expected (O/E) ratio was calculated as the number of unique providers seen by MA beneficiaries divided by the number expected based the TM prediction model. Multivariable linear models were used to assess the relationship between network restrictiveness and plan and market factors.Data Collection/Extraction MethodsPrescription drug event data were obtained for a 20% random sample of beneficiaries enrolled in prescription drug coverage from 2011 to 2017.Principal FindingsHealth Maintenance Organization plans were more restrictive (O/E = 55.5%; 95% CI 55.3%–55.7%) than Health Maintenance Organization‐Point of Service plans (67.2%; 95% CI 66.7%–67.8%) or Preferred Provider Organization plans (74.7%; 95% CI 74.3%–75.1%), and rural areas had more restrictive networks (31.6%; 95% CI 29.0%–34.2%) than metropolitan areas (61.5%; 95% CI 61.3%–61.7%). Multivariable results confirmed these findings, and also indicated that increased provider supply was associated with less restrictive networks.ConclusionsWe developed a means of estimating provider network restrictiveness in MA from claims data. Our results validate the approach, providing confidence for wider application (e.g., for other markets and specialties) and use for regulation.

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Comparison of Medicare Advantage vs Traditional Medicare for Health Care Access, Affordability, and Use of Preventive Services Among Adults With Low Income

Cited by 14 publications

References 23 publications

Association of Medicare Program Type with Health Care Access, Utilization, and Affordability among Cancer Survivors

Association of Medicare Program Type with Health Care Access, Utilization, and Affordability among Cancer Survivors

Evaluation of Potentially Avoidable Acute Care Utilization Among Patients Insured by Medicare Advantage vs Traditional Medicare

Measuring restrictiveness of Medicare Advantage networks: A claims‐based approach

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