Physician Network Breadth and Plan Quality Ratings in Medicare Advantage

Sen, Aditi P.; Meiselbach, Mark K.; Anderson, Kelly E.; Miller, Brian J.; Polsky, Daniel

doi:10.1001/jamahealthforum.2021.1816

Cited by 25 publications

(43 citation statements)

References 6 publications

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“…What might be leading to these differences in care experiences for enrollees with ADRD? Prior work has found that MA beneficiaries tend to be admitted to lower quality hospitals, nursing homes, and home health agencies than those in TM, 32–34 and that MA networks are often narrow in nature 4,35,36 . While all beneficiaries in our study are enrolled in MA, narrow networks and other barriers to care such as prior authorizations may be an additional burden for beneficiaries with ADRD to navigate than healthier enrollees.…”

Section: Discussionmentioning

confidence: 73%

“…Prior work has found that MA beneficiaries tend to be admitted to lower quality hospitals, nursing homes, and home health agencies than those in TM, [32][33][34] and that MA networks are often narrow in nature. 4,35,36 While all beneficiaries in our study are enrolled in MA, narrow networks and other barriers to care such as prior authorizations may be an additional burden for beneficiaries with ADRD to navigate than healthier enrollees. Enrollees with dementia may also face challenges in selecting the right plan for them, leading to lower-rated care experiences.…”

Section: Discussionmentioning

confidence: 99%

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Comparing the care experiences of Medicare Advantage beneficiaries with and without Alzheimer's disease and related dementias

Meyers

Rivera‐Hernandez

Kim

et al. 2022

J American Geriatrics Society

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Background: The Medicare Advantage (MA) program is rapidly growing.Limited evidence exists about the care experiences of MA beneficiaries with Alzheimer's Disease and Related Dementia (ADRD). Our objective was to compare care experiences for MA beneficiaries with and without ADRD. Methods:We examined MA beneficiaries who completed the Medicare Advantage Consumer Assessment of Healthcare Providers and Systems (CAHPS) and used inpatient, nursing home, or home health services in the past 3 years. We classified beneficiaries with ADRD using the presence of diagnosis codes in hospitals, nursing homes, and home health records. Our key measures included overall ratings of care and health plan, and indices of receiving timely care, care coordination, receiving needed care, and customer service. We compared differences between beneficiaries with and without ADRD using regression analysis adjusting for demographic, health, and plan characteristics, and stratifying by proxy response status.Results: Among beneficiaries sampled by CAHPS, 22.2% with ADRD completed the survey compared to 38.5% without ADRD. Among proxy responses, beneficiaries with ADRD were 4.2 (95% CI: 0.1-8.4) percentage points less likely to report a high score for receiving needed care, and 3.5 percentage points (95% CI: 0.2-6.9) less likely to report a high score for customer service.Among non-proxy responses, those with ADRD were 9.0 (95% CI: 5.5-12.5) percentage points less likely to report a high score for needed care, and 8.5 (95% CI: 5.4-11.5) percentage points less likely to report a high score for customer service.Conclusions: ADRD respondents to the CAHPS were more likely to be excluded from CAHPS performance measures because they did not meet eligibility requirements and rates of non-response were higher. Among responders with or without a proxy, MA enrollees with an ADRD diagnosis reported worse care experiences in receiving needed care and in customer service than those without an ADRD diagnosis.

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Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Comparing the care experiences of Medicare Advantage beneficiaries with and without Alzheimer's disease and related dementias

Meyers

Rivera‐Hernandez

Kim

et al. 2022

J American Geriatrics Society

View full text Add to dashboard Cite

show abstract

“…One-third of Medicare Advantage enrollees are in plans with narrow physician networks, although only one-fifth of consumers feel positively about narrow networks when other options are presented . Conversely, 2 recent studies have found narrow networks to be associated with higher quality for Medicare Advantage plans . Medicare Advantage payment rates are unlikely to be a direct mechanism given that we controlled for HRR in all analyses, making all comparisons within regions where payment rates are the same.…”

Section: Discussionmentioning

confidence: 97%

“… 3 Conversely, 2 recent studies have found narrow networks to be associated with higher quality for Medicare Advantage plans. 25 , 26 Medicare Advantage payment rates are unlikely to be a direct mechanism given that we controlled for HRR in all analyses, making all comparisons within regions where payment rates are the same.…”

Section: Discussionmentioning

confidence: 99%

Association of Medicare Advantage Premiums With Measures of Quality and Patient Experience

Haviland

Klein

et al. 2022

JAMA Health Forum

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ImportanceQuality of care varies substantially across Medicare Advantage plans. The price information that Medicare Advantage enrollees are most likely to consider when selecting a Medicare Advantage plan is the monthly premium. Enrollees may select plans to minimize premium or, alternatively, use premium as a proxy for quality and select plans with higher premiums; however, quality implications of these choices are unknown.ObjectiveTo determine the extent to which the quality of care offered by Medicare Advantage plans varies within vs across premium levels.Design, Setting, and ParticipantsThis was a retrospective cross-sectional study of the population enrolled in Medicare Advantage plans in 2016 to 2017 using clinical quality measures from the Healthcare Effectiveness Data and Information Set (HEDIS), patient experience measures from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys, and administrative data. Data were analyzed from March 2021 to March 2022.ExposuresMedicare Advantage monthly premium.Main Outcomes and MeasuresTen publicly reported 2017 HEDIS measures and 5 publicly reported 2017 CAHPS measures linearly transformed to a 0 to 100 scale.ResultsThe 168 968 Medicare Advantage CAHPS respondents were representative of the enrollee population (14% were <65 years old and eligible through disability; 24% ≥80 years old; sex and race/ethnicity data were not considered); 40% were in 591 plans with no monthly premiums and less than 6% were in 144 plans with monthly premiums of $120 or more. There were from 77 054 to 2 139 422 enrollees by HEDIS measure. Among all Medicare Advantage enrollees, 79% were in plans with either a $0 premium or a low monthly premium (≤$60); patient experience and clinical quality were generally similar in these 2 categories of plans. To a small extent, enrollees in moderately high ($60-$120) and high (≥$120) premium plans reported better patient experience (+1.4 [95% CI, 0.7-2.1] and 2.2 [95% CI, 1.5-2.9] points) and received better clinical care (1.4 [95% CI, 0.3-2.5] to 3.3 [5% CI, 2.1-4.5] percentage points on most measures than those with $0 and low-premium plans. Quality differences within each premium level category were substantial; the within-premium category plan-level SDs were 6.5 points and 7.2 percentage points for patient experience and clinical quality, respectively. A plan at the 50th percentile of clinical quality and patient experience in the high premium category would fall in the 65th and 62nd percentile within the $0-premium category, respectively.Conclusions and RelevanceThis population-based cross-sectional study found that although quality of care and patient experience were slightly higher with higher-premium plans, quality varied widely within each premium category. High-quality care and patient experience were found in each price category. Thus, paying higher premiums is not necessary for higher quality care in Medicare Advantage plans. Greater engagement of enrollees and advocates with quality of care and patient experience information for Medicare Advantage plan selection is recommended.

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“…As highly rated MA contracts establish networks with highly rated providers, this suggests that provider networks are a pathway used by MA contracts to improve outcomes. 8,9 The findings should be interpreted within several limitations. There may be selection into highly rated MA contracts.…”

Section: Discussionmentioning

confidence: 99%

Association of Medicare Advantage star ratings with patterns of end‐of‐life care

Park

Teno

White

et al. 2022

J American Geriatrics Society

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Physician Network Breadth and Plan Quality Ratings in Medicare Advantage

Abstract: This cross-sectional study examines the extent of narrow networks across Medicare Advantage, types of counties where they are common, enrollment in narrow network plans, and how networks are associated with star ratings.

Cited by 25 publications

References 6 publications

Comparing the care experiences of Medicare Advantage beneficiaries with and without Alzheimer's disease and related dementias

Comparing the care experiences of Medicare Advantage beneficiaries with and without Alzheimer's disease and related dementias

Association of Medicare Advantage Premiums With Measures of Quality and Patient Experience

Association of Medicare Advantage star ratings with patterns of end‐of‐life care

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