Recent Growth In Medicare Advantage Enrollment Associated With Decreased Fee-For-Service Spending In Certain US Counties

Abstract

Recent increases in Medicare Advantage enrollment may have caused lower spending growth in the fee-for-service (FFS) Medicare population. We identified the counties of largest Medicare Advantage growth and determined if increased enrollment was associated with reduced FFS Medicare spending growth in those counties. We found that 73 percent of counties experienced at least a 5-percentage-point increase in Medicare Advantage penetration between 2007 and 2014, with the most growth occurring in larger and poorer counties in the Northeast and South. The association between Medicare Advantage growth and FFS Medicare costs varied depending on baseline Medicare Advantage penetration: In counties with low baseline penetration, Medicare Advantage growth did not have a significant effect on per capita FFS Medicare spending, whereas in counties in the highest quartile of baseline Medicare Advantage penetration, it was associated with a significant decrease in FFS Medicare spending growth ($154 annually per 10-percentage-point increase in Medicare Advantage). These findings suggest that Medicare Advantage growth may be playing a role in moderating FFS Medicare costs.

Encouraging Medicare Advantage Enrollees to Switch to Higher Quality Plans: Assessing the Effectiveness of a “Nudge” Letter

“…One recent study has also reported that Medicare Advantage penetration is continuing to grow and that this growth is concentrated in lower income counties. 2 This suggests that nudge letters could play a bigger role in driving enrollments into higher quality plans as beneficiaries continue to gain more coverage options over time, particularly in potentially underserved areas.…”

“…1 The number and share of enrollees in Medicare Advantage program have continued to increase through the past decade. 2 …”

Radiation Oncology Physician Practice in the Modern Era: A Statewide Analysis of Medicare Reimbursement

“…The GEE models provided robust standard errors due to the potential correlation between radiation oncologists in the same practice. Similarly, because the proportion of Medicare Advantage participants within the county could influence outcomes, subsequent GEEs for all three outcomes were constructed, clustering by county and the results served to confirm the original models with respect to practice setting [18]. …”

“…The importance of competition in predicting patient volume was facilitated by use of the Herfindahl-Hirschman Index [17]. Importantly, clustering by county mitigated the potential effect of variable participation in Medicare Advantage plans [18].…”

Radiation Oncology Physician Practice in the Modern Era: A Statewide Analysis of Medicare Reimbursement

“…The GEE models provided robust standard errors due to the potential correlation between radiation oncologists in the same practice. Similarly, because the proportion of Medicare Advantage participants within the county could influence outcomes, subsequent GEEs for all three outcomes were constructed, clustering by county and the results served to confirm the original models with respect to practice setting [18]. Analyses for global Medicare reimbursement as an outcome excluded physicians in any hospital-based practice.…”