Psychometric evaluation of the Medicare Advantage and prescription drug plan disenrollment reasons survey

Martino, Steven C.; Elliott, Marc N.; Zaslavsky, Alan M.; Orr, Nathan; Bogart, Andy; Ye, Feifei; Damberg, Cheryl L.

doi:10.1111/1475-6773.13160

Cited by 4 publications

(3 citation statements)

References 14 publications

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“…Evidence of the strong psychometric properties of these measures is reported elsewhere. [31][32][33][34] These measures are described in more detail in Appendix Table 1 (Supplemental Digital Content 1, http://links.lww.com/MLR/C360).…”

Section: Outcome Measuresmentioning

confidence: 99%

Disparities in Care Experienced by Older Hispanic Medicare Beneficiaries in Urban and Rural Areas

et al. 2021

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Background: Hispanic older adults face substantial health disparities compared with non-Hispanic-White (hereafter "White") older adults. To the extent that these disparities stem from cultural and language barriers faced by Hispanic people, they may be compounded by residence in rural areas.Objective: The objective of this study was to investigate possible interactions between Hispanic ethnicity and rural residence in predicting the health care experiences of older adults in the United States, and whether disparities in care for rural Hispanic older adults differ in Medicare Advantage versus Medicare Fee-for-Service.Subjects: Medicare beneficiaries age 65 years and older who responded to the 2017-2018 nationally representative Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys. Methods:We fit a series of linear, case-mix-adjusted models predicting Medicare CAHPS measures of patient experience (rescaled to a 0-100 scale) from ethnicity, place of residence, and Medicare coverage type.Results: In all residential areas, Hispanic beneficiaries reported worse experiences with getting needed care (−3 points), getting care quickly (−4 points), and care coordination (−1 point) than White beneficiaries (all P's < 0.001). In rural areas only, Hispanic beneficiaries reported significantly worse experiences than White beneficiaries on doctor communication and customer services (−3 and −9 points, respectively, P < 0.05). Tests of a 3-way interaction between ethnicity, rural residence, and coverage type were nonsignificant.Conclusions: There is a need to improve access to care and care coordination for Hispanic beneficiaries overall and doctor-patient communication and customer service for rural Hispanic beneficiaries. Strategies for addressing deficits faced by rural Hispanics may involve cultural competency training and provision of language-appropriate services for beneficiaries (perhaps as telehealth services).

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Section: Outcome Measuresmentioning

confidence: 99%

Disparities in Care Experienced by Older Hispanic Medicare Beneficiaries in Urban and Rural Areas

et al. 2021

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“…Identifying mechanisms may require linking the data used in this study with information from additional data sources, such as the MA and Prescription Drug Plan Disenrollment Reasons Survey. 36 Data from that survey could provide clues about racial/ethnic minority beneficiaries' principal reasons for leaving their plans and how those reasons differ from the ones cited by White beneficiaries. If stratified disenrollment rates could be linked to Medicare Plan Finder data, it may be possible to identify the characteristics of MA plans with disenrollment rates that are particularly high or low for racial/ ethnic minority beneficiaries.…”

Section: Discussionmentioning

confidence: 99%

“…Finally, our study does not identify the mechanisms driving the described racial/ethnic differences. Identifying mechanisms may require linking the data used in this study with information from additional data sources, such as the MA and Prescription Drug Plan Disenrollment Reasons Survey 36. Data from that survey could provide clues about racial/ethnic minority beneficiaries’ principal reasons for leaving their plans and how those reasons differ from the ones cited by White beneficiaries.…”

Section: Discussionmentioning

confidence: 99%

Rates of Disenrollment From Medicare Advantage Plans Are Higher for Racial/Ethnic Minority Beneficiaries

et al. 2021

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Background: Each year, about 10% of Medicare Advantage (MA) enrollees voluntarily switch to another MA contract, while another 2% voluntarily switch from MA to fee-for-service Medicare. Voluntary disenrollment from MA plans is related to beneficiaries’ negative experiences with their plan, disrupts the continuity of care, and conflicts with goals to reduce Medicare costs. Little is known about racial/ethnic disparities in voluntary disenrollment from MA plans. Objective: The objective of this study was to investigate differences in rates of voluntary disenrollment from MA plans by race/ethnicity. Subjects: A total of 116,770,319 beneficiaries enrolled in 736 MA plans in 2015. Methods: Differences in rates of disenrollment across racial/ethnic groups [Asian or Pacific Islander (API), Black, Hispanic, and White] were summarized using 4 types of logistic regression models: adjusted and unadjusted models estimating overall differences and adjusted and unadjusted models estimating within-plan differences. Unadjusted overall models included only racial/ethnic group probabilities as predictors. Adjusted overall models added age, sex, dual eligibility, disability, and state of residence as control variables. Between-plan differences were estimated by subtracting within-plan differences from overall differences. Results: Adjusted rates of disenrollment were significantly (P<0.001) higher for Hispanic (+1.2 percentage points), Black (+1.2 percentage points), and API beneficiaries (+2.4 percentage points) than for Whites. Within states, all 3 racial/ethnic minority groups tended to be concentrated in higher disenrollment plans. Within plans, API beneficiaries voluntarily disenrolled considerably more often than otherwise similar White beneficiaries. Conclusion: These findings suggest the need to address cost, information, and other factors that may create barriers to racial/ethnic minority beneficiaries’ enrollment in plans with lower overall disenrollment rates.

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Patient administrative burden in the US health care system

Kyle

Frakt

2021

Health Services Research

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Objective To assess the prevalence of patient administrative tasks and whether they are associated with delayed and/or foregone care. Data Source March 2019 Health Reform Monitoring Survey. Study Design We assess the prevalence of five common patient administrative tasks—scheduling, obtaining information, prior authorizations, resolving billing issues, and resolving premium problems—and associated administrative burden, defined as delayed and/or foregone care. Using multivariate logistic models, we examined the association of demographic characteristics with odds of doing tasks and experiencing burdens. Our outcome variables were five common types of administrative tasks as well as composite measures of any task, any delayed care, any foregone care, and any burden (combined delayed/foregone), respectively. Data Collection We developed and administered survey questions to a nationally representative sample of insured, nonelderly adults (n = 4155). Principal Findings The survey completion rate was 62%. Seventy‐three percent of respondents reported performing at least one administrative task in the past year. About one in three task‐doers, or 24.4% of respondents overall, reported delayed or foregone care due to an administrative task: Adjusted for demographics, disability status had the strongest association with administrative tasks (adjusted odds ratio [OR] 2.91, p < 0.001) and burden (adjusted OR 1.66, p < 0.001). Being a woman was associated with doing administrative tasks (adjusted OR 2.19, p < 0.001). Being a college graduate was associated with performing an administrative task (adjusted OR 2.79, p < 0.001), while higher income was associated with fewer subsequent burdens (adjusted OR 0.55, p < 0.01). Conclusions Patients frequently do administrative tasks that can create burdens resulting in delayed/foregone care. The prevalence of delayed/foregone care due to administrative tasks is comparable to similar estimates of cost‐related barriers to care. Demographic disparities in burden warrant further attention. Enhancing measurement of patient administrative work and associated burdens may identify opportunities for assessing quality, value, and patient experience.

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Psychometric evaluation of the Medicare Advantage and prescription drug plan disenrollment reasons survey

Cited by 4 publications

References 14 publications

Disparities in Care Experienced by Older Hispanic Medicare Beneficiaries in Urban and Rural Areas

Disparities in Care Experienced by Older Hispanic Medicare Beneficiaries in Urban and Rural Areas

Rates of Disenrollment From Medicare Advantage Plans Are Higher for Racial/Ethnic Minority Beneficiaries

Patient administrative burden in the US health care system

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