Does the Racial/Ethnic Composition of Medicare Advantage Plans Reflect Their Areas of Operation?

Weinick, Robin M.; Haviland, Amelia; Hambarsoomian, Katrin; Elliott, Marc N.

doi:10.1111/1475-6773.12100

Cited by 10 publications

(18 citation statements)

References 15 publications

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“…Previous research suggests that such concentration is greater than expected from the racial/ethnic composition of the geographic location alone (Weinick et al. ).…”

Section: Resultsmentioning

confidence: 87%

“…; Weinick et al. ). Their providers and contracts deliver care that is, on average, rated more poorly than care delivered by providers and contracts with fewer minorities (Rodriguez et al.…”

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confidence: 97%

“…Racial/ethnic minorities are often clustered within physician practices, hospitals, and MA contracts to a greater degree than would be expected by chance (Rodriguez et al 2008;Weinick et al 2014). Their providers and contracts deliver care that is, on average, rated more poorly than care delivered by providers and contracts with fewer minorities (Rodriguez et al 2008;Goldstein et al 2010;Haviland et al 2011;Orr et al 2013).…”

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confidence: 99%

“…Concentration of minorities in particular MA contracts may also be explained, in part, by these contracts having lower out-of-pocket costs (Atherly and Thorpe 2005). Weinick et al (2014) notes that new special needs plans (SNPs), the first plans that allow eligibility requirements based on low income or chronic condition, substantially concentrate racial/ethnic minorities in contracts relative to the racial/ethnic composition of their operational area, perhaps because the beneficiaries eligible for SNPs are disproportionately likely to be racial/ethnic minorities.…”

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confidence: 99%

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Do Experiences with Medicare Managed Care Vary According to the Proportion of Same‐Race/Ethnicity/Language Individuals Enrolled in One's Contract?

Price

Haviland

Hambarsoomian

et al. 2015

Health Services Research

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Objective To examine whether care experiences and immunization for racial/ethnic/language minority Medicare beneficiaries vary with the proportion of same‐group beneficiaries in Medicare Advantage (MA) contracts. Data Sources/Study Setting Exactly 492,495 Medicare beneficiaries responding to the 2008–2009 MA Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey. Data Collection/Extraction Methods Mixed‐effect regression models predicted eight CAHPS patient experience measures from self‐reported race/ethnicity/language preference at individual and contract levels, beneficiary‐level case‐mix adjustors, along with contract and geographic random effects. Principal Findings As a contract's proportion of a given minority group increased, overall and non‐Hispanic, white patient experiences were poorer on average; for the minority group in question, however, high‐minority plans may score as well as low‐minority plans. Spanish‐preferring Hispanic beneficiaries also experience smaller disparities relative to non‐Hispanic whites in plans with higher Spanish‐preferring proportions. Conclusions The tendency for high‐minority contracts to provide less positive patient experiences for others in the contract, but similar or even more positive patient experiences for concentrated minority group beneficiaries, may reflect cultural competency, particularly language services, that partially or fully counterbalance the poorer overall quality of these contracts. For some beneficiaries, experiences may be just as positive in some high‐minority plans with low overall scores as in plans with higher overall scores.

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“…Previous research suggests that such concentration is greater than expected from the racial/ethnic composition of the geographic location alone (Weinick et al. ).…”

Section: Resultsmentioning

confidence: 87%

mentioning

confidence: 97%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Do Experiences with Medicare Managed Care Vary According to the Proportion of Same‐Race/Ethnicity/Language Individuals Enrolled in One's Contract?

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Haviland

Hambarsoomian

et al. 2015

Health Services Research

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“…Differences in willingness to pay for quality among minorities relative to white beneficiaries (greater for Hispanic beneficiaries and lesser for black beneficiaries) could reflect targeted marketing or historical enrollment patterns, given the disproportionate minority enrollment observed in some plans. 28 Greater Figure 2. Beneficiary willingness to pay in annual combined health and drug plan premiums and out-of-pocket costs for star ratings, by subgroup.…”

Section: Discussionmentioning

confidence: 99%

The Roles of Cost and Quality Information in Medicare Advantage Plan Enrollment Decisions: an Observational Study

et al. 2015

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BACKGROUND:To facilitate informed decision-making in the Medicare Advantage marketplace, the Centers for Medicare & Medicaid Services publishes plan information on the Medicare Plan Finder website, including costs, benefits, and star ratings reflecting quality. Little is known about how beneficiaries weigh costs versus quality in enrollment decisions. OBJECTIVE: We aimed to assess associations between publicly reported Medicare Advantage plan attributes (i.e., costs, quality, and benefits) and brand market share and beneficiaries' enrollment decisions. DESIGN, SETTING, PARTICIPANTS: We performed a nationwide, beneficiary-level cross-sectional analysis of 847,069 beneficiaries enrolling in Medicare Advantage for the first time in 2011. MAIN MEASURES: Matching beneficiaries with their plan choice sets, we used conditional logistic regression to estimate associations between plan attributes and enrollment to assess the proportion of enrollment variation explained by plan attributes and willingness to pay for quality. KEY RESULTS: Relative to the total variation explained by the model, the variation in plan choice explained by premiums (25.7 %) and out-of-pocket costs (11.6 %) together explained nearly three times as much as quality ratings (13.6 %), but brand market share explained the most variation (35.3 %). Further, while beneficiaries were willing to pay more in total annual combined premiums and out-of-pocket costs for higher-rated plans (from $4,154.93 for 2.5-star plans to $5,698.66 for 5-star plans), increases in willingness to pay diminished at higher ratings, from $549.27 (95 %CI: $541.10, $557.44) for a rating increase from 2.5 to 3 stars to $68.22 (95 %CI: $61.44, $75.01) for an increase from 4.5 to 5 stars. Willingness to pay varied among subgroups: beneficiaries aged 64-65 years were more willing to pay for higherrated plans, while black and rural beneficiaries were less willing to pay for higher-rated plans. CONCLUSIONS: While beneficiaries prefer higher-quality and lower-cost Medicare Advantage plans, marginal utility for quality diminishes at higher star ratings, and their decisions are strongly associated with plans' brand market share.

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Medicare Advantage Enrollment Among Beneficiaries With End-Stage Renal Disease in the First Year of the 21st Century Cures Act

Nguyen

Meyers

et al. 2023

JAMA

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ImportanceBefore 2021, most Medicare beneficiaries with end-stage renal disease (ESRD) were unable to enroll in private Medicare Advantage (MA) plans. The 21st Century Cures Act permitted these beneficiaries to enroll in MA plans effective January 2021.ObjectiveTo examine changes in MA enrollment among Medicare beneficiaries with ESRD after enactment of the 21st Century Cures Act overall and by race or ethnicity and dual-eligible status.Design, Setting, and ParticipantsThis cross-sectional time-trend study used data from Medicare beneficiaries with ESRD (both kidney transplant recipients and those undergoing dialysis) between January 2019 and December 2021. Data were analyzed between June and October 2022.Exposures21st Century Cures Act.Main Outcomes and MeasuresPrimary outcomes were the proportion of Medicare beneficiaries with prevalent ESRD who switched from traditional Medicare to MA between 2020 and 2021 and those with incident ESRD who newly enrolled in MA in 2021. Individuals who stayed in traditional Medicare were enrolled in 2020 and 2021 and those who switched to MA were enrolled in traditional Medicare in 2020 and MA in 2021.ResultsAmong 575 797 beneficiaries with ESRD in 2020 or 2021 (mean [SD] age, 64.7 [14.2] years, 42.2% female, 34.0% Black, and 7.7% Hispanic or Latino), the proportion of beneficiaries enrolled in MA increased from 24.8% (December 2020) to 37.4% (December 2021), a relative change of 50.8%. The largest relative increases in MA enrollment were among Black (72.8% relative increase), Hispanic (44.8%), and dual-eligible beneficiaries with ESRD (73.6%). Among 359 617 beneficiaries with TM and prevalent ESRD in 2020, 17.6% switched to MA in 2021. Compared with individuals who stayed in traditional Medicare, those who switched to MA had modestly more chronic conditions (6.3 vs 6.1; difference, 0.12 conditions [95% CI, 0.10-0.16]) and similar nondrug spending in 2020 (difference, $509 [95% CI, −$58 to $1075]) but were more likely to be Black (difference, 19.5 percentage points [95% CI, 19.1-19.9]) and have dual Medicare-Medicaid eligibility (difference, 20.8 percentage points [95% CI, 20.4-21.2]). Among beneficiaries who were newly eligible for Medicare ESRD benefits in 2021, 35.2% enrolled in MA.Conclusions and RelevanceResults suggest that increases in MA enrollment among Medicare beneficiaries with ESRD were substantial the first year after the 21st Century Cures Act, particularly among Black, Hispanic, and dual-eligible individuals. Policy makers and MA plans may need to assess network adequacy, disenrollment, and equity of care for beneficiaries who enrolled in MA.

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Does the Racial/Ethnic Composition of Medicare Advantage Plans Reflect Their Areas of Operation?

Abstract: These findings provide a baseline profile that will enable crucial ongoing monitoring to assess how the implementation of Quality Bonus Payments may affect MA plan coverage of minority populations.

Cited by 10 publications

References 15 publications

Do Experiences with Medicare Managed Care Vary According to the Proportion of Same‐Race/Ethnicity/Language Individuals Enrolled in One's Contract?

Do Experiences with Medicare Managed Care Vary According to the Proportion of Same‐Race/Ethnicity/Language Individuals Enrolled in One's Contract?

The Roles of Cost and Quality Information in Medicare Advantage Plan Enrollment Decisions: an Observational Study

Medicare Advantage Enrollment Among Beneficiaries With End-Stage Renal Disease in the First Year of the 21st Century Cures Act

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