PMU50 COMPARING UTILIZATION, COST AND QUALITY IN DUAL ELIGIBLE MEDICARE ADVANTAGE AND FEE-FOR-SERVICE MEDICARE BENEFICIARIES

This study assessed the odds of dying in hospital associated with enrollment in Medicare Advantage (M-A) versus conventional Medicare Fee-for-Service (M-FFS). Data were derived from the 2008 and 2010 waves of the Health and Retirement Study ( n = 1,030). The sample consisted of elderly Medicare beneficiaries who died in 2008–2010 (34% died in hospital, and 66% died at home, in long-term senior care, a hospice facility, or other setting). Logistic regression estimated the odds of dying in hospital for those continuously enrolled in M-A from 2008 until death compared to those continuously enrolled in M-FFS and those switching between the two plans. Results indicate that decedents continuously enrolled in M-A had 43% lower odds of dying in hospital compared to those continuously enrolled in M-FFS. Financial incentives in M-A contracts may reduce the odds of dying in hospital.

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How Do the Hospital Prices Paid by Medicare Advantage Plans and Commercial Plans Compare With Medicare Fee-for-Service Prices?

INQUIRY The Journal of Health Care Organization Provision and Financing ◽

10.1177/0046958018779654 ◽

2018 ◽

Vol 55 ◽

pp. 004695801877965

Author(s):

Jared Lane K. Maeda ◽

Lyle Nelson

Keyword(s):

Health Care ◽

Acute Care ◽

Health Care Cost ◽

Acute Care Hospitals ◽

Fee For Service ◽

Medicare Advantage ◽

Medicare Beneficiaries ◽

Metropolitan Statistical Areas

The prices that private insurers pay hospitals have received considerable attention in recent years, but most of that literature has focused on the commercially insured population. Although nearly one-third of Medicare beneficiaries are enrolled in a Medicare Advantage (MA) plan, little is known about the prices paid to hospitals by the private insurers that administer such plans. More information on the hospital prices paid by MA plans would provide additional insights into whether MA prices are more closely tied to Medicare fee-for-service (FFS) prices or commercial prices. Moreover, information on whether the hospital prices paid by MA plans vary with market characteristics or other factors would be useful for evaluating the performance of the MA program and analyzing proposals to modify it. In this study, we compared the hospital prices paid by MA plans and commercial plans with Medicare FFS prices using 2013 claims from the Health Care Cost Institute (HCCI) database. The HCCI claims were used to calculate hospital prices for private insurers, and Medicare’s payment rules were used to estimate Medicare FFS prices. We focused on stays at acute care hospitals in metropolitan statistical areas (MSAs). We found MA prices to be roughly equal to Medicare FFS prices, on average, but commercial prices were 89% higher than FFS prices. In addition, commercial prices varied greatly across and within MSAs, but MA prices varied much less.

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Could Improving Choice and Competition in Medicare Advantage be the Future of Medicare?

Forum for Health Economics & Policy ◽

10.1515/fhep-2015-0046 ◽

2015 ◽

Vol 18 (2) ◽

pp. 151-168 ◽

Cited By ~ 2

Author(s):

Alice M. Rivlin ◽

Willem Daniel

Keyword(s):

Rural Areas ◽

Urban Areas ◽

Competitive Bidding ◽

Fee For Service ◽

Medicare Advantage ◽

Medicare Beneficiaries ◽

Meaningful Improvement ◽

Service Plan ◽

The Cost ◽

Do So

Abstract About 30 percent of Medicare beneficiaries enroll in private Medicare Advantage (MA) plans but do so at a relatively high-cost. This paper explores the advantages and challenges of introducing competitive bidding among MA plans (Plan One) or among MA plans and Fee-for-Service (Plan Two or Premium Support). We conclude that competitive bidding could reduce the cost of Medicare, especially in densely populated urban areas. However, there would be serious challenges in rural areas and risk adjustment methodology would have to be substantially improved. In Plan Two, sicker beneficiaries might move to Fee-for-Service and beneficiaries might have to pay more to stay with a preferred provider or broader network. If these problems are addressed, we believe that premium support can be a meaningful improvement to the MA program.

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Medicare Advantage Enrollment and Beneficiary Risk Scores: Difference-in-Differences Analyses Show Increases for All Enrollees On Account of Market-Wide Changes

INQUIRY The Journal of Health Care Organization Provision and Financing ◽

10.1177/0046958018788640 ◽

2018 ◽

Vol 55 ◽

pp. 004695801878864

Author(s):

Tamara Beth Hayford ◽

Alice Levy Burns

Keyword(s):

Health Maintenance Organization ◽

Risk Scores ◽

Intensity Difference ◽

Fee For Service ◽

Medicare Advantage ◽

Medicare Beneficiaries ◽

Difference In Differences ◽

Health Maintenance ◽

Duration Effect ◽

The Relationship

Medicare adjusts payments to Medicare Advantage (MA) insurers using risk scores that summarize the relationship between fee-for-service (FFS) Medicare spending and beneficiaries’ demographic characteristics and documented health conditions. Research shows that MA insurers have increasingly documented conditions more thoroughly than traditional Medicare—resulting in higher payments to insurers—but little is known about what factors contribute to diverging risk scores. We apportion that divergence between market-wide increases and increases that vary with length of MA enrollment. We also examine whether effects vary across plan types and whether the enrollment duration effect is contingent upon remaining with the same insurer. Using Medicare administrative data from 2008 to 2013, we employ a difference-in-differences model to compare the growth in risk scores of Medicare beneficiaries who switch from FFS to MA to that of beneficiaries who remain in FFS. We find that the effect of MA enrollment on risk scores increased from 5% in 2009 to 8% in 2012 and that continuous enrollment in MA was associated with an additional 1.2% increase per year, regardless of continuous enrollment with an insurer. Thus, even among those who switched to MA in 2009, enrollment duration comprised less than one-third of the coding intensity difference in 2012. We also find that risk scores grew faster in areas with greater MA penetration and among Health Maintenance Organization enrollees. Overall, our findings suggest that market-wide factors contributed most to the increasing divergence between FFS and MA risk scores.

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Outcomes after carotid endarterectomy among elderly dual Medicare-Medicaid–eligible patients

Neurology ◽

10.1212/wnl.0000000000006380 ◽

2018 ◽

Vol 91 (17) ◽

pp. e1553-e1558 ◽

Cited By ~ 2

Author(s):

Erica C. Leifheit ◽

Yun Wang ◽

George Howard ◽

Virginia J. Howard ◽

Larry B. Goldstein ◽

...

Keyword(s):

Carotid Endarterectomy ◽

Mixed Models ◽

Significant Interaction ◽

Clinical Characteristics ◽

Study Cohort ◽

Fee For Service ◽

Medicare Beneficiaries ◽

All Cause Mortality ◽

Dual Eligible ◽

The Relationship

ObjectiveTo determine whether patients who are dual eligible for Medicare and Medicaid benefits have outcomes after carotid endarterectomy (CEA) that are comparable to the outcomes of those eligible for Medicare alone.MethodsThe study cohort included fee-for-service Medicare beneficiaries ≥65 years of age who underwent CEA (ICD-9-CM code 38.12) between 2003 and 2010. Beneficiaries with ≥1 month of Medicaid coverage were considered dual eligible. We fit mixed models to assess the relationship between coverage (dual eligible vs Medicare only) and outcomes over time after adjustment for demographic and clinical characteristics.ResultsThere were 53,773 dual-eligible and 452,182 Medicare-only beneficiaries hospitalized for CEA. The percentage of dual-eligible patients receiving CEA increased from 10.1% in 2003 to 11.5% in 2010, with no change in geographic distribution across the country. In adjusted analyses, dual-eligible vs Medicare-only beneficiaries had a higher rate of 30-day ischemic stroke or death; higher in-hospital, 30-day, and 1-year all-cause mortality; and higher 30-day all-cause readmission. Relative annual reductions in outcomes from 2003 to 2010 ranged from 2% to 5%, but there was no significant interaction between dual-eligible status and time.ConclusionsDual-eligible beneficiaries had worse outcomes than those eligible for Medicare alone. Additional work is necessary to understand the reasons for this difference.

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Predictors of Disenrollment Among Medicare Fee-for-Service Beneficiaries With Dementia

Innovation in Aging ◽

10.1093/geroni/igab046.062 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 18-18

Author(s):

Maricruz Rivera-Hernandez ◽

Aaron Castillo ◽

Amal Trivedi

Keyword(s):

Chronic Conditions ◽

Fixed Effects ◽

Regression Models ◽

Primary Outcome ◽

Fee For Service ◽

Medicare Advantage ◽

Medicare Beneficiaries ◽

Race Ethnicity ◽

Dual Eligibility ◽

Care Costs

Abstract Medicare enrollment among people with Alzheimer’s Disease and Related Dementias (ADRD) has reached an all-time high with about 12% of beneficiaries having an ADRD diagnosis. The federal government has special interest in providing healthcare alternatives for Medicare beneficiaries. However, limited studies have focused on understanding disenrollment from fee-for-service, especially among those with high-needs. In this study we identified predictors of disenrollment among beneficiaries with ADRD. We used the 2017-2018 Medicare Master Beneficiary Summary File to determine enrollment, sociodemographic, clinical characteristics and healthcare utilization. We included all fee-for-service beneficiaries enrolled in 2017 who survived the first quarter of 2018. Our primary outcome was disenrollment from fee-for-service between 2017 and 2018. Regression models included age, sex, race/ethnicity, dually eligibility to Medicare and Medicaid, chronic and disabling conditions (categorized by quartiles), total health care costs including outpatient, inpatient, post-acute care and other costs (categorized by quartiles) and county fixed-effects. There were 1,797,047 beneficiaries enrolled in fee-for-service with an ADRD diagnosis. Stronger predictors of disenrollment included race/ethnicity and dual eligibility. Disenrollment rates were 7.9% (95% CI, 7.2 – 8.5) among African Americans, 6.6 (95% CI, 6.2 – 7.0) among Hispanics and 4.3 (95% CI, 4.2 – 4.3) among Whites. Duals were 1.9% (95% CI, 1.4 – 2.3) more likely to disenroll from fee-for-service to Medicare Advantage (MA). The inclusion of MA special need plans and additional benefits for those with ADRD and complex chronic conditions may be valuable for those beneficiaries with ADRD, and who may not have Medigap coverage when enrolling in fee-for-service.

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Hospitals spend less for patients in Medicare Advantage than for patients in fee-for-service Medicare

PsycEXTRA Dataset ◽

10.1037/e504352010-032 ◽

2009 ◽

Keyword(s):

Fee For Service ◽

Medicare Advantage

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Aligning Medicaid and Medicare Advantage Managed Care Plans for Dual-Eligible Beneficiaries

Medical Care Research and Review ◽

10.1177/10775587211018938 ◽

2021 ◽

pp. 107755872110189

Author(s):

Laura M. Keohane ◽

Zilu Zhou ◽

David G. Stevenson

Keyword(s):

Nursing Home ◽

Managed Care ◽

Prescription Drugs ◽

Service Use ◽

Medicare Advantage ◽

Percentage Point Increase ◽

Care Plans ◽

Point Increase ◽

Dual Eligible ◽

Home Users

To coordinate Medicare and Medicaid benefits, multiple states are creating opportunities for dual-eligible beneficiaries to join Medicare Advantage Dual-Eligible Special Needs Plans (D-SNPs) and Medicaid plans operated by the same insurer. Tennessee implemented this approach by requiring insurers who offered Medicaid plans to also offer a D-SNP by 2015. Tennessee’s aligned D-SNP participation increased from 7% to 24% of dual-eligible beneficiaries aged 65 years and above between 2011 and 2017. Within a county, a 10-percentage-point increase in aligned D-SNP participation was associated with 0.3 fewer inpatient admissions ( p = .048), 13.9 fewer prescription drugs per month ( p = .048), and 0.3 fewer nursing home users ( p = .06) per 100 dual-eligible beneficiaries aged 65 years and older. Increased aligned plan participation was associated with 0.2 more inpatient admissions ( p = .004) per 100 dual-eligible beneficiaries younger than 65 years. For some dual-eligible beneficiaries, increasing Medicare and Medicaid managed plan alignment has the potential to promote more efficient service use.

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Obstructive Sleep Apnea Treatment and Dementia Risk in Older Adults

SLEEP ◽

10.1093/sleep/zsab076 ◽

2021 ◽

Author(s):

G L Dunietz ◽

R D Chervin ◽

J F Burke ◽

A S Conceicao ◽

T J Braley

Keyword(s):

Older Adults ◽

Statistical Significance ◽

Fee For Service ◽

Medicare Beneficiaries ◽

Lower Odds ◽

Logistic Regression Models ◽

Not Otherwise Specified ◽

Dementia Risk ◽

Obstructive Sleep ◽

Study Participants

Abstract Study Objectives To examine associations between PAP therapy, adherence and incident diagnoses of Alzheimer’s disease (AD), mild cognitive impairment (MCI), and dementia not-otherwise-specified (DNOS) in older adults. Methods This retrospective study utilized Medicare 5% fee-for-service claims data of 53,321 beneficiaries, aged 65+, with an OSA diagnosis prior to 2011. Study participants were evaluated using ICD-9 codes for neurocognitive syndromes [AD(n=1,057), DNOS(n=378), and MCI(n=443)] that were newly-identified between 2011-2013. PAP treatment was defined as presence of ≥1 durable medical equipment (HCPCS) code for PAP supplies. PAP adherence was defined as ≥2 HCPCS codes for PAP equipment, separated by≥1 month. Logistic regression models, adjusted for demographic and health characteristics, were used to estimate associations between PAP treatment or adherence and new AD, DNOS, and MCI diagnoses. Results In this sample of Medicare beneficiaries with OSA, 59% were men, 90% were non-Hispanic whites and 62% were younger than 75y. The majority (78%) of beneficiaries with OSA were prescribed PAP (treated), and 74% showed evidence of adherent PAP use. In adjusted models, PAP treatment was associated with lower odds of incident diagnoses of AD and DNOS (OR=0.78, 95% CI:0.69-0.89; and OR=0.69, 95% CI:0.55-0.85). Lower odds of MCI, approaching statistical significance, were also observed among PAP users (OR=0.82, 95% CI:0.66-1.02). PAP adherence was associated with lower odds of incident diagnoses of AD (OR=0.65, 95% CI:0.56-0.76). Conclusions PAP treatment and adherence are independently associated with lower odds of incident AD diagnoses in older adults. Results suggest that treatment of OSA may reduce risk of subsequent dementia.

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