Dropped out or pushed out? Insurance market exit and provider market power in Medicare Advantage

Pelech, Daria

doi:10.1016/j.jhealeco.2016.11.003

Cited by 3 publications

(2 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Often, insurers that cancelled the PFFS plans replaced those products with PPOs or HMOs. 28 As a result, many beneficiaries who switched contracts may have moved from a cancelled PFFS plan to the same insurer’s PPO or HMO. When we redefined the length of time with the insurer to reflect the parent organization (which would address those plan cancellations), the insurer duration term was no longer significant.…”

Section: Resultsmentioning

confidence: 99%

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

Hayford

Burns

2018

INQUIRY

View full text Add to dashboard Cite

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.

show abstract

Section: Resultsmentioning

confidence: 99%

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

Hayford

Burns

2018

INQUIRY

View full text Add to dashboard Cite

show abstract

“…This may be the result of overall consolidation in the insurance market, but also may have arisen from direct features of the managed care structure of MA plans. For example, Medicare policies changed in 2011 to require all MA plans to create provider networks, which prompted some health insurers to cancel up to ⅔ of the affected plans and resulted in increased consolidation (Pelech, 2017). Expanding MA-style plans may need to accommodate these features to adequately encourage competition.…”

Section: Medicare Advantagementioning

confidence: 99%

Managed competition in the United States: How well is it promoting equity and efficiency?

Ellis,

Hoagland,

Acquatella

2024

HEPL

View full text Add to dashboard Cite

Managed competition frameworks aim to control healthcare costs and promote access to high-quality health insurance and services through a combination of public policies and market forces. In the United States, managed competition delivery systems are varied and diffused across a patchwork of divided markets and populations. This, coupled with extremely high national health spending per capita, makes a more unified managed competition strategy an appealing alternative to a currently struggling healthcare system. We examine the relative effectiveness of three existing programmes in the U.S. that each rely upon some principles of managed competition: health insurance exchanges instituted by the Affordable Care Act, Medicaid managed care organisations, and Medicare Advantage plans. Although each programme leverages some competitive features, each faces significant hurdles as a candidate for expansion. We highlight these challenges with a survey of academic health economists, and find that provider and insurer consolidation, highly segmented markets, and failing to incentivise competitive efficiencies all dampen the success of existing programmes. Although managed competition for all is a potentially desirable framework for future health reform in the U.S., successful expansion relies on addressing fundamental issues revealed by imperfect existing programmes.

show abstract

Paying more for less? Insurer competition and health plan generosity in the Medicare Advantage program

Pelech

2018

Journal of Health Economics

View full text Add to dashboard Cite

Dropped out or pushed out? Insurance market exit and provider market power in Medicare Advantage

Cited by 3 publications

References 36 publications

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

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

Managed competition in the United States: How well is it promoting equity and efficiency?

Paying more for less? Insurer competition and health plan generosity in the Medicare Advantage program

Contact Info

Product

Resources

About