HomeHealth CareSpending more on Medicare Advantage doesn't seem to buy better health

Spending more on Medicare Advantage doesn’t seem to buy better health


Members of Medicare Advantage and traditional Medicare visit hospitals and emergency departments with the same frequency, even though those enrolled in the privatized program receive more care management services, a new report finds.

Thirty-four percent of traditional Medicare and Medicare Advantage members age 65 and older visited an emergency department during the two-year period between 2016 and 2018, by For example, according to an analysis published by the Commonwealth Fund Thursday.

Hospitalization rates were also similar: 28% of Medicare Advantage members and 27% of traditional Medicare members visited a hospital during those two years.

The researchers drew on data from the 2018 Medicare Current Beneficiaries Survey and a Commonwealth Fund survey conducted this year. The researchers separately evaluated information on beneficiaries eligible for Medicare and Medicaid through special needs plans when the sample sizes were sufficient.

The similarities in patient outcomes raise the question why Medicare Advantage plans cost the government more than fee-for-service Medicare, particularly as enrollment in privatized healthcare programs grows, said Vice President Gretchen Jacobson of the Commonwealth Fund Medicare and author of the report. .

By 2025, half of all eligible beneficiaries are expected to be enrolled in Medicare Advantage. Brokers and agents may receive higher compensation for enrolling seniors in Medicare Advantage than Medicare supplement plans that pair with part A. other part B, create financial incentives to recommend Medicare Advantage, according to a separate Commonwealth Fund study posted on Tuesday.

“What is the value of these additional services if the results are the same?” Jacobson said. “It’s really important for the government and legislators to look at this, given that Medicare Advantage plans right now charge more than it would cost to provide the same care to people with traditional Medicare.”

In addition to the slightly different patient outcomes, the researchers found that people enrolled in both programs had comparable rates of chronic conditions and identified along similar racial, ethnic, and economic lines, not including those enrolled in special needs plans.

The similarity between the two groups of affiliates represents a historic change for the privatized health program.

As recently as 2015, Medicare Advantage enrollees were younger and included a higher proportion of racial and ethnic minorities and low-income people compared to traditional Medicare, according to an independent report. Commonwealth Fund report issued last year. Beneficiaries of private Medicare plans also had more complex needs, according to the study, but the analysis did not separate those enrolled in special needs plans from other Medicare Advantage members.

As the program matures, the differences between patients have leveled out in Medicare Advantage and Fee-for-Service Medicare, with 41% of traditional Medicare enrollees having at least three chronic conditions compared to 43% of enrollees Medicare Advantage. The prevalence of arthritis, cancer, diabetes, and depression is about the same among traditional Medicare and Medicare Advantage members.

The new study did not consider the severity of these conditions. Previous analyzes have shown that people in Medicare Advantage plans consume fewer services after adjusting for health conditions, suggestion is population ailments is it so no What severe compared to the fee-for-service population. Medicare Advantage members with diabetes, asthma, breast cancer or prostate cancer had lower spending rates than people on fee-for-service Medicare with the same conditions, according to a 2019 report. Kaiser Family Foundation Study.

“We have really seen an expansion of Medicare Advantage plans across the country since [Affordable Care Act], including an expansion in the number of companies offering Medicare Advantage plans, as well as expansions to many parts of the country, “said Jacobson.” That could help explain the equalization of patient populations. ”

However, the composition of patients among dual-eligible special needs plans differed from both fee-for-service and those enrolled only in Medicare Advantage plans.

Dual-eligible individuals enrolled in Medicare Advantage were significantly more likely to have at least three chronic conditions than those enrolled in the other programs, with 43% reporting at least three chronic conditions and 50% saying they were diagnosed with at least six chronic conditions. .

Special needs plan beneficiaries were also more than twice as likely to identify as black and three times more likely to identify as Latino than those enrolled in Medicare Advantage or traditional Medicare. These populations are statistically more like be low-income and have worse health than white people. White people are also less likely to enroll in special needs plans.

Providers of Medicare Advantage special needs plans serve a “very vulnerable population,” Jacobson said. “It really draws attention to the fact that special needs plans need a closer look with perhaps a different policy lens because they are serving such a needy population. They could be a focus of equity-related policies.”



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