scholarly journals Favorable Risk Selection in Medicare Advantage: Trends in Mortality and Plan Exits Among Nursing Home Beneficiaries

2016 ◽  
Vol 74 (6) ◽  
pp. 736-749 ◽  
Author(s):  
Elizabeth M. Goldberg ◽  
Amal N. Trivedi ◽  
Vincent Mor ◽  
Hye-Young Jung ◽  
Momotazur Rahman
Keyword(s):  
Nursing Home ◽  
Risk Adjustment ◽  
Risk Selection ◽  
Medicare Advantage ◽  
Medicare Beneficiaries ◽  
Payment Model ◽  
Mortality Difference ◽  
Switch Rate ◽  
Reduced Risk

The 2003 Medicare Modernization Act (MMA) increased payments to Medicare Advantage plans and instituted a new risk-adjustment payment model to reduce plans’ incentives to enroll healthier Medicare beneficiaries and avoid those with higher costs. Whether the MMA reduced risk selection remains debatable. This study uses mortality differences, nursing home utilization, and switch rates to assess whether the MMA successfully decreased risk selection from 2000 to 2012. We found no decrease in the mortality difference or adjusted difference in nursing home use between plan beneficiaries pre- and post the MMA. Among beneficiaries with nursing home use, disenrollment from Medicare Advantage plans declined from 20% to 12%, but it remained 6 times higher than the switch rate from traditional Medicare to Medicare Advantage. These findings suggest that the MMA was not associated with reductions in favorable risk selection, as measured by mortality, nursing home use, and switch rates.

scholarly journals Plan Switching and Stickiness in Medicare Advantage: A Qualitative Interview With Medicare Advantage Beneficiaries

2020 ◽  
pp. 107755872094428
Author(s):  
Maricruz Rivera-Hernandez ◽  
Kristy L. Blackwood ◽  
Kyle A. Moody ◽  
Amal N. Trivedi
Keyword(s):  
Nursing Home ◽  
Qualitative Interview ◽  
Nursing Home Care ◽  
Medicare Advantage ◽  
Medicare Beneficiaries ◽  
Major Health ◽  
Quantitative Evidence ◽  
Semistructured Interviews ◽  
Health Event ◽  
Current Plan

Approximately 34% of all Medicare beneficiaries were enrolled in a Medicare Advantage (MA) plan in 2019. Quantitative evidence suggests that MA beneficiaries have low rates of switching plans, but that beneficiaries who are hospitalized or use postacute nursing home care are disproportionately more likely to exit their plan. This research sought to explore how MA enrollees choose plans and the factors involved in their decision to keep their current plan or switch plans. We conducted 25 semistructured interviews focusing on expectations and experiences preenrollment and postenrollment among MA beneficiaries. Overall, the beneficiaries interviewed reported being highly satisfied with their plans. After selecting a plan, there was little incentive to revisit their choice since they viewed their plan as “good enough.” Confusion, health status, cost and benefits also contributed to many seniors keeping or switching their plans. These seniors were reluctant to switch plans unless they experienced a major health event.

scholarly journals How Does Risk Selection Respond to Risk Adjustment? New Evidence from the Medicare Advantage Program

2014 ◽  
Vol 104 (10) ◽  
pp. 3335-3364 ◽  
Author(s):  
Jason Brown ◽  
Mark Duggan ◽  
Ilyana Kuziemko ◽  
William Woolston
Keyword(s):  
Adverse Selection ◽  
Risk Adjustment ◽  
Medical Costs ◽  
Risk Selection ◽  
Health Plans ◽  
Medicare Advantage ◽  
Capitation Payments ◽  
New Evidence

To combat adverse selection, governments increasingly base payments to health plans and providers on enrollees' scores from risk-adjustment formulae. In 2004, Medicare began to risk-adjust capitation payments to private Medicare Advantage (MA) plans to reduce selection-driven overpayments. But because the variance of medical costs increases with the predicted mean, incentivizing enrollment of individuals with higher scores can increase the scope for enrolling “overpriced” individuals with costs significantly below the formula's prediction. Indeed, after risk adjustment, MA plans enrolled individuals with higher scores but lower costs conditional on their score. We find no evidence that overpayments were on net reduced. (JEL G22, H51, I13, I18)

PACE and the Medicare+Choice Risk-Adjusted Payment Model

2001 ◽  
Vol 38 (1) ◽  
pp. 60-72 ◽  
Author(s):  
Helena Temkin-Greener ◽  
Mark R. Meiners ◽  
Leonard Gruenberg
Keyword(s):  
Risk Adjustment ◽  
The Elderly ◽  
Medicare Beneficiaries ◽  
Balanced Budget Act ◽  
Functional Impairments ◽  
Payment Model ◽  
Care For The Elderly ◽  
Diagnostic Cost ◽  
Balanced Budget ◽  
The Impact

This paper investigates the impact of the Medicare principal inpatient diagnostic cost group (PIP-DCG) payment model on the Program of All-Inclusive Care for the Elderly (PACE). Currently, more than 6,000 Medicare beneficiaries who are nursing home certifiable receive care from PACE, a program poised for expansion under the Balanced Budget Act of 1997. Overall, our analysis suggests that the application of the PIP-DCG model to the PACE program would reduce Medicare payments to PACE, on average, by 38%. The PIP-DCG payment model bases its risk adjustment on inpatient diagnoses and does not capture adequately the risk of caring for a population with functional impairments.

scholarly journals How does Risk Selection Respond to Risk Adjustment? Evidence from the Medicare Advantage Program

2011 ◽  
Author(s):  
Jason Brown ◽  
Mark Duggan ◽  
Ilyana Kuziemko ◽  
William Woolston
Keyword(s):  
Risk Adjustment ◽  
Risk Selection ◽  
Medicare Advantage

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

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.

Contending with Risk Selection in Health Insurance Markets in Germany

2006 ◽  
Vol 7 (Supplement) ◽  
pp. 75-91 ◽  
Author(s):  
Jacob Glazer ◽  
Thomas G. McGuire
Keyword(s):  
Health Insurance ◽  
Risk Adjustment ◽  
Simple Approach ◽  
Insurance Markets ◽  
Risk Selection ◽  
Health Plans ◽  
Health Insurance Markets ◽  
The U.S

Abstract In many countries, competition among health plans or sickness funds raises issues of risk selection. Funds may discourage or encourage potential enrollees from joining, and these actions may have efficiency or fairness implications. This article reviews the experience in the U.S., and comments on the evidence for risk selection in Germany. There is little evidence that risk selection causes efficiency problems in Germany, but risk selection does lead to an inequality in contribution rates. A simple approach to equalizing contribution rates that does not involve risk adjustment is presented and discussed.

New York’s Medicare Marketplace: Examining New York’s Medicare Advantage Plan Landscape in Light of Payment Reform

2013 ◽  
Vol 14 (3) ◽  
pp. 187-196 ◽  
Keyword(s):  
New York ◽  
Performance Metrics ◽  
New York State ◽  
Cost Savings ◽  
Medicare Advantage ◽  
Medicare Beneficiaries ◽  
Payment Reform ◽  
Cost Structures ◽  
Sound Policy ◽  
And Performance

The Patient Protection and Affordable Care Act (ACA) provided for cost savings in the Medicare program, in part to underwrite coverage expansion to Medicare beneficiaries, to finance new coverage for those not eligible for Medicare, and to strengthen Medicare’s financial outlook. One cost-saving measure, a reformulation and reduction in payments to private health insurance plans that provide Medicare benefits through the Medicare Advantage (MA) program, had a sound policy basis but was criticized, particularly by opponents of the ACA, as a measure that would lead to increased costs, reductions in benefits, and diminished plan choices to Medicare beneficiaries enrolled in MA plans. Despite dire predictions to this effect, a review of a sample of MA plan offerings in New York State in 2012 shows that Medicare beneficiaries enrolled in such plans did not experience significant benefit reductions or increased costs. While the number of plan offerings decreased, the reduction was mostly caused by the elimination of duplicative plan choices in 2011. Although the MA plan executives we interviewed indicated that further reductions in plan reimbursement in future years—tempered by potential bonus payments for meeting quality and performance metrics—could impact plan costs and benefits, they believed plans will employ a number of strategies to remain in the market and maintain beneficiary benefits and cost structures. However, government regulators and consumer advocates will need to examine MA plan offerings in the coming years to determine the effect of plan reaction to the ACA payments on beneficiaries’ costs for coverage and access to care.

Sign in / Sign up

Export Citation Format

Share Document