Examining annual transitions in healthcare spending among U.S. medicare beneficiaries using multistate Markov models: Analysis of medicare current beneficiary survey data, 2003–2019

Li, Lihua; Zhan, Serena; McKendrick, Karen; Chen, Yang; Mazumdar, Madhu; Kelley, Amy S.; Aldridge, Melissa D.

doi:10.1016/j.pmedr.2023.102171

Cited by 2 publications

(1 citation statement)

References 32 publications

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“…The 7-year, 50% increase of high-need beneficiaries in TM (in this analysis, IAH-qualified beneficiaries), and the increase in their share of TM parts A and B spending, highlights the need for effective TM programs to meet the needs of this critical population. The finding that the share of IAH-qualified beneficiaries is higher in TM than MA is consistent with findings from other work: longitudinal studies from the Medicare Current Beneficiary Survey and analysis of Medicare claims have suggested a greater concentration of complex and frail beneficiaries in TM . Both beneficiary choice (beneficiaries who switch from MA to TM are more likely to have functional dependencies) and provider network selection (practices with more complex and expensive panels are less likely to be included in MA networks) may contribute to the finding.…”

Section: Discussionsupporting

confidence: 89%

Prevalence of Independence at Home–Qualifying Beneficiaries in Traditional Medicare, 2014-2021

Lally,

Johnson,

Deligiannidis

et al. 2024

JAMA Netw Open

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ImportanceThe Centers for Medicare &amp; Medicaid Services Innovation Center Independence at Home (IAH) demonstration, a test of home-based primary care operating in a value-based shared-savings payment model, ended December 2023 after a decade of consistently showing savings to Medicare. It is important to assess whether high-need, IAH-qualified beneficiaries continue to pose a growing challenge to traditional Medicare (TM) or if Medicare Advantage (MA), with programmatic features favorable to caring for this subset of the general Medicare population, can disproportionately provide such care.ObjectiveTo examine the size and share of IAH-qualified beneficiaries in TM and MA.Design, Setting, and ParticipantsThis cohort study used all Medicare claims data and MA encounter data for 2014 and 2021. IAH qualifying criteria were applied to the TM populations enrolled in Parts A and B in 2014 and 2021, and to MA enrollees in 2021. Growth in the number of IAH-qualified TM beneficiaries from 2014 to 2021 was calculated, and the proportions and numbers of IAH-qualified enrollees in the total 2021 TM and MA populations were compared. Data were analyzed between April and June 2023.Main Outcomes and MeasuresThe number and share of beneficiaries meeting IAH criteria in TM and MA; the share of TM spending among IAH-qualified beneficiaries.ResultsAmong 64 million Medicare beneficiaries in 2021, there were 30.55 million beneficiaries in TM with Parts A and B coverage, down from 33.82 million in 2014. The number of IAH-qualified beneficiaries in TM grew 51%, from 2.16 million to 3.27 million, while their proportionate share in TM grew 67% from 6.4% to 10.7% of TM between 2014 and 2021. IAH-qualified beneficiaries represented $155 billion in 2021 Medicare Parts A and B spending, 44% of all TM spending, up from 29% of total spending in 2014. In 2021, 2.15 million IAH-qualified beneficiaries represented 8.0% of Medicare Advantage enrollees. Combining TM and MA, 5.42 million IAH-qualified beneficiaries represented 9.3% of all Medicare beneficiaries, with 3.27 million (60.3%) being insured by TM.Conclusions and RelevanceIn this cohort study of IAH-qualified Medicare beneficiaries, the share of IAH-qualified beneficiaries in TM grew between 2014 and 2021, with 60% of Medicare high-need beneficiaries accounting for 44% of TM spending. The Centers for Medicare &amp; Medicaid Services should continue to operate value-based programs like IAH that are specifically designed for these high-needs individuals.

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