Association Between Double Bonuses and Clinical and Administrative Performance in Medicare Advantage

Ryan, Andrew M.; Gulseren, Baris; Ayanian, John Z.; Markovitz, Adam A.; Meyers, David J.; Brown, Erin C. Fuse

doi:10.1001/jamahealthforum.2022.3301

Cited by 2 publications

(2 citation statements)

References 3 publications

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“…A difference-in-differences (D-I-D) estimate is the difference between the difference in treatment post- and pre-parameter estimates, and the difference in control post- and pre-parameter estimates, sometimes referred to as a controlled before and after study as participants serve as their own controls. The D-I-D estimates the between-group cross-sectional differences and the within-group time series differences to measure treatment effects [ 37 , 38 , 39 , 40 , 41 , 42 ]. We tested the dummy variable for inadequate health literacy as a fixed effect in all outcome models as it is a key factor in this study.…”

Section: Methodsmentioning

confidence: 99%

Health Support for At-Risk Older Adults during COVID-19

Ryan¹,

Gibbs

Sehgal

2023

Healthcare

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Older adults are highly susceptible to COVID-19 infection and at the highest risk for severe disease and death. Yet, older adults lacked access to accurate and easy-to-use COVID-19 information and support early in the pandemic. This prospective, experimental cohort study sought to examine whether older adults could be engaged during the pandemic through a community partner and if a low-touch intervention, designed with health literacy best practices, could positively impact COVID-19 knowledge, mitigation behaviors, telehealth/doctor visits, exercise, and loneliness. A senior resource kit was distributed to older adults sheltering at home through food assistance program agents from October 2020 to February 2021; the kit was developed using health literacy best practices. Simple random assignment was used to divide program participants into treatment and control groups. Both groups received senior kits, but the treatment group also received telephonic health coaching. The primary outcome was COVID-19 knowledge and mitigation behaviors as derived from self-reported surveys at baseline and after four months. Secondary outcomes included a telehealth or doctor visit, exercise frequency, and a loneliness score (3-Item Loneliness Scale). Health literacy was assessed using the BRIEF screening tool. Ninety-eight older adults consented to participate in the study and 87 completed the study (88.7% completion rate). Participants had moderate clinical risk, one-third preferred the Spanish language, and 52% were categorized as having inadequate or marginal health literacy. Significant changes were found for increasing COVID-19 mitigation behaviors and the frequency of exercise across the cohort, but not for COVID-19 knowledge, telehealth visits, or decreasing loneliness. Conclusions: Partnering with a trusted entity in the community is a feasible and important strategy to reach older adults during a lockdown and provide them with easy-to-read health information and resources. If the time horizon had been longer, improvements in other outcome variables may have been achieved.

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Section: Methodsmentioning

confidence: 99%

Health Support for At-Risk Older Adults during COVID-19

Ryan¹,

Gibbs

Sehgal

2023

Healthcare

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“…6,11 By lowering their bids in response to lower benchmarks, plans can shield their rebates from the benchmark cut, thus maintaining their plan generosity for beneficiaries. Second, new ACA-related quality bonuses, 12 which included a doubling of the quality bonus program bonuses in certain counties, were strong buffers against the benchmark cuts.…”

Section: Newer Evidencementioning

confidence: 99%

What Will Cuts to Medicare Advantage Payments Do to Enrollment?

Song

2023

JAMA Health Forum

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Half of US Medicare beneficiaries are now enrolled in Medicare Advantage (MA)-a share that is expected to exceed 60% by 2032. 1 Despite the increasing importance of MA for policy makers and the delivery system, the effect of payment policy on plans and beneficiaries remains relatively understudied. More evidence is needed to better understand the effects of potential federal efforts to slow MA payments, such as recent regulations to curtail incentives for MA coding intensity, which tend to generate substantial controversy. 2 This type of controversy will likely intensify, as efforts to slow Medicare spending increasingly consider or involve MA. MA Payment SystemMedicare Advantage is a publicly financed, privately administered arm of the Medicare program. Key policy issues in MA can be contextualized within a 4-step process (Figure 3-5 ). First, the Centers for Medicare & Medicaid Services (CMS) publishes a benchmark payment rate for each county-an amount that CMS is willing to pay a private plan for enrolling a beneficiary of average risk. This key element of plan payments can be thought of as an offer, an upper limit on the government's defined contribution, reflecting what the government estimates a private plan would need to take care of a beneficiary of average risk. Second, each MA plan chooses the counties it would like to offer coverage in and submits a plan-level bid to CMS for those counties. This bid is a counteroffer-the amount that the plan thinks it needs to take care of a beneficiary of average risk across those counties.Third, CMS compares the plan's bid to the benchmarks in those counties and determines the final plan payment. If the bid exceeds the benchmark, CMS pays the benchmark, and plans would need to ask for the difference from beneficiaries through a monthly premium. But if the bid is below the benchmark, CMS pays plans their bid along with a rebate-a bonus that plans can use to offer additional benefits (eg, vision, dental, hearing coverage) or buy down a beneficiary's cost sharing or premiums. This rebate, boosting plan generosity, is a proportion of the difference between the bid and the benchmark, with the exact percentage (50%-70%) determined by the plan's quality (star) rating. Thus, for a given plan, the lower its bid, the larger its rebate. The larger its rebate, the more attractive it can be for enrollees. Finally, in step 4, Medicare beneficiaries make enrollment decisions among plans in their county and the traditional Medicare option.

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Association Between Double Bonuses and Clinical and Administrative Performance in Medicare Advantage

Abstract: This cross-sectional study compares double bonuses with clinical and administrative performance in Medicare Advantage facilities.

Cited by 2 publications

References 3 publications

Health Support for At-Risk Older Adults during COVID-19

Health Support for At-Risk Older Adults during COVID-19

What Will Cuts to Medicare Advantage Payments Do to Enrollment?

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