Impact of Continued Biased Disenrollment from the Medicare Advantage Program to Fee-for-Service

Riley, Gerald F.

doi:10.5600/mmrr.002.04.a08

Cited by 12 publications

(7 citation statements)

References 13 publications

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“…We find that high-need and dual-eligible enrollees have substantially higher disenrollment rates when compared with non–high-need enrollees. This finding aligns with that of the recent Government Accountability Office report on disenrollment and other recent examples from the literature that suggest that MA plans may not currently meet the preferences of high-need enrollees. We also found large movement of TM enrollees into MA during the study period, particularly among dual-eligible beneficiaries, indicating a high level of switching in this population.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Drivers of Disenrollment and Plan Switching Among Medicare Advantage Beneficiaries

et al. 2019

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IMPORTANCE How often enrollees with complex care needs leave the Medicare Advantage (MA) program and what might drive their decisions remain unknown. OBJECTIVE To characterize trends in switching to and from MA among high-need beneficiaries and to evaluate the drivers of disenrollment decisions. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study of MA and traditional Medicare (TM) enrollees from January 1, 2014, through December 31, 2015, used a multinomial logit regression stratified by Medicare-Medicaid eligibility status. All 14 589 645 non-high-need MA enrollees and 1302 470 high-need enrollees in the United States who survived until the end of 2014 were eligible for the analysis. Data were analyzed from November 1, 2017, through August 1, 2018. EXPOSURES Enrollee dual eligibility and high-need status (based on complex chronic conditions, multiple morbidities, use of health care services, functional impairment, and frailty indicators), MA plan star rating, and cost sharing. MAIN OUTCOMES AND MEASURES The proportion of enrollees who disenrolled into TM, remained in the same MA plan, or who switched plans within the MA program. RESULTS A total of 13 901 816 enrollees were included in the analysis (56.2% women; mean [SD] age, 70.9 [9.9] years). Among the 1302 470 high-need enrollees, an adjusted 4.6% (95% CI, 4.5%-4.6%) of Medicare-only and 14.8% (95% CI, 14.5%-15.0%) of Medicare-Medicaid members switched from MA to TM compared with 3.3% (95% CI, 3.3%-3.3%) and 4.6% (95% CI, 4.5%-4.7%), respectively, among non-high-need enrollees. Among enrollees in low-quality plans, 23.0% (95% CI, 22.3%-23.9%) of Medicare and 42.8% (95% CI, 40.5%-45.1%) of dual-eligible high-need enrollees left MA. Even in high-quality plans, high-need members disenrolled at higher rates than non-high-need members (4.9% [95% CI, 4.6%-5.2%] vs 1.8% [95% CI, 1.8%-1.9%] for Medicare-only enrollees and 11.3% vs 2.4% dual eligible enrollees). Enrollment in a 5.0-star rated plan was associated with a 30.1-percentage point reduction (95% CI, −31.7 to −28.4 percentage points) in the probability of disenrollment among high-need individuals. A $100 increase in monthly premiums was associated with a 33.9–percentage point increase (95% CI, −34.9 to −33.0 percentage points) in the likelihood of switching plans, and a small reduction in the likelihood of disenrolling (−2.7 percentage points; 95% CI, −3.2 to −2.2 percentage points). Among Medicare-Medicaid eligible participants, 14.1% (95% CI, 14.0%-14.2%) of high-need and 16.7% (95% CI, 16.6%-16.7%) of non-high-need enrollees switched from TM to MA. CONCLUSIONS AND RELEVANCE Results of this study suggest that substantially higher disenrollment from MA plans occurs among high-need and Medicare-Medicaid eligible enrollees. This study’s findings suggest that star ratings have the strongest association with disenrollment trends, whereas increases in monthly premiums are associated with greater likelihood of switching plans.

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Section: Discussionmentioning

confidence: 99%

Analysis of Drivers of Disenrollment and Plan Switching Among Medicare Advantage Beneficiaries

et al. 2019

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“…The old QMs reflect care provided to all residents while the new QMs include only fee-for-service Medicare residents and do not include MA enrollees. As the penetration of MA is highly variable across states 14 and the medical management and health of MA residents may differ in unobserved ways, 38 this may also lead to measurement-related differences between the old and the new QMs and, hence, lack of correlation.…”

Section: Discussionmentioning

confidence: 99%

Examination of the New Short-Stay Nursing Home Quality Measures: Rehospitalizations, Emergency Department Visits, and Successful Returns to the Community

Saliba

Weimer

Shi

et al. 2018

INQUIRY

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In 2016, the Centers for Medicare & Medicaid Services (CMS) introduced 3 new quality measures (QMs) to its report card, Nursing Home Compare (NHC). These measures—rehospitalizations, emergency department visits, and successful discharges to the community—focus on short-stay residents. We offer a first analysis of nursing homes’ performance in terms of these new measures. We examined their properties and distribution across nursing homes using descriptive statistics and regression models. We found that, similar to other QMs, performance varies across the country, and that there is very minimal correlation between these 3 new QMs as well as between these QMs and other NHC QMs. Regression models reveal that better performance on these QMs tends to be associated with fewer deficiencies, higher staffing and more skilled staffing, nonprofit ownership, and lower proportion of Medicaid residents. Other characteristics are associated with better performance for some but not all 3 QMs. We also found improvement in all 3 QMs in the second year of publication. This study contributes to the validity of these measures by demonstrating their relationship to these structural QMs. It also suggests that these QMs are important by demonstrating their large variation across the country, suggesting substantial room for improvement, and finding that nursing homes are already responding to the incentives created by publication of these QMs.

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“…One explanation for this varying effect may be due to differences in the population of patients who undergo noncomplex versus complex cataract surgery. CMS has found that patients with worse health and who require more expensive medical care are more likely to disenroll in Medicare Advantage plans, thus shifting the composition of Medicare Advantage enrollees toward a greater proportion of healthier patients (Riley ). As a result, a rise in Medicare Advantage enrollment may have little impact on complex cataract service volume if patients most likely to undergo complex cataract extraction are not enrolling in Medicare Advantage plans.…”

Section: Discussionmentioning

confidence: 99%

Trends in Medicare Service Volume for Cataract Surgery and the Impact of the Medicare Physician Fee Schedule

Gong

Lin

Tsai

2016

Health Services Research

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Impact of Continued Biased Disenrollment from the Medicare Advantage Program to Fee-for-Service

Cited by 12 publications

References 13 publications

Analysis of Drivers of Disenrollment and Plan Switching Among Medicare Advantage Beneficiaries

Analysis of Drivers of Disenrollment and Plan Switching Among Medicare Advantage Beneficiaries

Examination of the New Short-Stay Nursing Home Quality Measures: Rehospitalizations, Emergency Department Visits, and Successful Returns to the Community

Trends in Medicare Service Volume for Cataract Surgery and the Impact of the Medicare Physician Fee Schedule

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