Three recent NIA-funded studies analyzed aspects of the Medicare Advantage program, including quality incentives, hospitalization services and the use of spending.According to a study published in JAMA Health ForumThe Medicare Advantage Program reduces the use of hospitalization services and beneficiary spending compared to traditional Medicare.. Two other studies published in Health Affairs We found that Medicare Advantage’s Quality Bonus Program did not improve plan quality or registration. In addition, one study found that Medicare Advantage’s double bonus payments created racial disparities in the distribution of Medicare funds and had a significant impact on black Medicare beneficiaries.
Medicare Advantage and Quality Bonus Program
Medicare Advantage is a federal health insurance program funded by the United States that provides Medicare benefits through the plans of private insurance companies. The various Medicare Advantage plans, sometimes referred to as “Part C” or “MA Plans,” have their own healthcare network that includes doctors and care facilities.
In 2012, Medicare introduced a quality bonus program to provide financial incentives to Medicare Advantage Plans to achieve a high quality rating. The plan is rated 1 to 5 stars based on more than 40 factors that assess how much care the plan provides, such as preventive services, chronic disease management, and customer service. For the highly acclaimed Medicare Advantage Plan, Medicare pays a bonus equivalent to 5% of the amount the plan receives for benefit management. This bonus doubles to 10% for county plans with high registrations and low service fees and a history of Medicare spending, if paid individually to a doctor or clinic for each service provided to a patient. increase.
Healthcare use and spending at Medicare Advantage over traditional Medicare
To compare the effectiveness of enrolling in the Medicare Advantage Plan with traditional Medicare, research teams at Harvard University and the University of Pennsylvania analyzed claim data from a single private insurance company. This allowed researchers to assess the use and spending of health care by older people in the transition from group or individual health insurance plans to Medicare.
During the first year of Medicare coverage, Medicare Advantage beneficiaries spent less hospital use and spend, estimated at $ 95 per beneficiary per month, compared to traditional Medicare. This reduced 63 hospital or long-term care stays per 1,000 beneficiaries annually. There was no significant change in the use or spending of specialized services such as seeing a doctor. Compared to traditional Medicare, Medicare Advantage was associated with an overall reduction of 36% in total medical costs in the first year of insurance coverage.The results of these findings were published in JAMA Health Forum..
Medicare Advantage Quality Bonus Program
A national study led by a team at the University of Michigan used health insurance claim data to assess the effectiveness of the Medicare Advantage Quality Bonus Program to improve planning performance. Claim information for 2009-2018 was collected for adults aged 50 to 74 years who are enrolled in either a Medicare Advantage plan or a commercial health insurance plan with no quality bonus incentives. Researchers evaluated data on changes in nine indicators of Medicare Healthcare Plan quality, both before and after the start of the bonus program.
The bonus program was associated with significant quality improvements for Medicare Advantage beneficiaries in four measures, but there was a significant decline in the other four measures, making a significant change in the overall quality performance of Medicare Advantage Plans. There wasn’t. The results of these surveys are Health AffairsIn contrast to the program’s goals, the quality bonus suggests that it did not improve the overall quality of the Medicare Advantage plan.
Medicare Advantage Double Bonus Payment
In another study, a team at the University of Michigan analyzed the impact of the Medicare Advantage double bonus on plan quality and other factors. The team used Medicare data from 2008 to 2018 to compare plan quality and enrollment trends before and after the introduction of bonuses in double bonus counties and ineligible counties. Surprisingly, they found that double bonuses were not associated with improved plan quality or increased plan enrollment.
Examining the impact of double bonuses on payments across the Medicare Advantage plan, researchers found that between 2012 and 2018, Double Bonus County plans received an estimated $ 10.2 billion more than ineligible county plans. discovered. In addition, the study showed that black beneficiaries were 35% less likely to live in counties eligible for double bonuses than white beneficiaries. As a result, the distribution of Medicare Double Bonus payments to the Medicare Advantage Plan was on average less to care for black beneficiaries compared to white beneficiaries. Researchers plan to serve white beneficiaries with a double bonus between 2012 and 2018, using an average annual difference of $ 31 per black beneficiary. We estimated that we received $ 446 million more care than the plan to serve the beneficiaries.The results of these findings were published in Health Affairs..
Future outlook
The findings from these studies provide important insights for policy makers to consider when making decisions about future Medicare payment policies. Additional research is needed to understand the differences in the quality of Medicare Advantage plan beneficiaries and the potential impact of double bonus payments on the racial health inequalities of black beneficiaries.
This study was partially supported by a NIA grant P01AG032952 and 2P01AG032952-11.
References
Schwartz AL, et al. Medicare Advantages and Healthcare Uses and Expenditures in Traditional Medicare: Difference Analysis. JAMA Health Forum. 2021; 2 (12): e214001. Doi: 10.1001 / jamahealthforum.2021.4001.
Markovitz AA and other Medicare Advantage quality bonus programs do not improve the quality of the plan. Health Affairs. 2021; 40 (12): 1918-1925. Doi: 10.1377 / hlthaff.2021.00606.
The double bonuses on the Markovitz AA and other Medicare Advantage plans promote racial disparities in payments and do not improve quality or registration. Health Affairs. 2021; 40 (9): 1411-1419. Doi: 10.1377 / hlthaff.2021.00349.
