Quality of Care for White and Hispanic Medicare Advantage Enrollees in the United States and Puerto Rico

Rivera‐Hernandez, Maricruz; Leyva, Bryan; Keohane, Laura M.; Trivedi, Amal N.

doi:10.1001/jamainternmed.2016.0267

Cited by 41 publications

(52 citation statements)

References 10 publications

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“…Regardless of the cause, we should make more efforts to increase these QIs in Japan. On the other hand, the QI about glycaemic control examinations in the present study was better than that in studies from the US [12,13] and comparable to studies from European countries [14]; we consider that the titration of glycaemic control based on HbA1c or GA levels works better in Japan thanks to wellestablished laboratory systems and/or frequent visits of outpatients [17].…”

Section: Discussionsupporting

confidence: 67%

“…In the US and European countries, QIs about retinopathy and nephropathy screening were higher than those measured in the present study [11][12][13][14][15]. This may be because pay-forperformance or accreditation systems are more prevalent in those countries than in Japan.…”

Section: Discussionmentioning

confidence: 59%

“…For glycated haemoglobin (HbA1c) measurement, its result has also been evaluated (outcome measure) [9,10]. Through these efforts, process measures in quality of diabetes care are generally fair or satisfactory in the US and Europe [11][12][13][14][15], although variation in quality of diabetes care by state has been reported in the US [16].…”

Section: Introductionmentioning

confidence: 99%

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Variation in process quality measures of diabetes care by region and institution in Japan during 2015–2016: An observational study of nationwide claims data

Sugiyama

Imai

Ihana‐Sugiyama

et al. 2019

Diabetes Research and Clinical Practice

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Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 59%

Section: Introductionmentioning

confidence: 99%

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Variation in process quality measures of diabetes care by region and institution in Japan during 2015–2016: An observational study of nationwide claims data

Sugiyama

Imai

Ihana‐Sugiyama

et al. 2019

Diabetes Research and Clinical Practice

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“…Finally, this study provides insights on the potential reasons to explain the differences in care and outcomes between TM and MA beneficiaries. 14,15 The study showed that shorter LOS and better functional improvements among MA beneficiaries were more likely to happen in freestanding IRFs than in those within the same acute care hospitals, which implies the potential power of care coordination across facilities within managed care networks. These findings were also in line with those of previous studies 13,22 claiming that facility attributes contributed substantially to care delivery and outcomes.…”

Section: Heterogeneous Differences By Insurance Typementioning

confidence: 99%

“…12,13 Third, this study is also closely related to the general literature on the scientific inquiry of the mechanisms that contribute to the differences in care delivery and outcomes between TM and MA. [14][15][16] This study attempted to disentangle and quantify the relative strength of patient-level, facility-level, and regional care system-level variations that contribute to the differences between TM and MA in inpatient rehabilitation services.…”

Section: Introductionmentioning

confidence: 99%

Assessment of Differences in Inpatient Rehabilitation Services for Length of Stay and Health Outcomes Between US Medicare Advantage and Traditional Medicare Beneficiaries

et al. 2020

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IMPORTANCE Enrollment in Medicare Advantage (MA) has been increasing and has reached one-third of total Medicare enrollment. Because of data limitations, direct comparison of inpatient rehabilitation services between MA and traditional Medicare (TM) beneficiaries has been very scarce. Subgroups of elderly individuals admitted to inpatient rehabilitation facilities (IRFs) may experience different care outcomes by insurance types. OBJECTIVE To measure the differences in length of stay and health outcomes of inpatient rehabilitation services between TM and MA beneficiaries in the US. DESIGN, SETTING, AND PARTICIPANTS This multiyear cross-sectional study used the Uniform Data System for Medical Rehabilitation to assess rehabilitation services received by elderly (aged >65 years) Medicare beneficiaries in IRFs between 2007 and 2016 for stroke, hip fracture, and joint replacement. Generalized linear models were used to assess whether an association existed between Medicare insurance type and IRF care outcomes. Models were adjusted for demographic characteristics, clinical conditions, and facility characteristics. Data were analyzed from September 2018 to August 2019. EXPOSURES Medicare insurance plan type, TM or MA. MAIN OUTCOMES AND MEASURES Inpatient length of stay in IRFs, functional improvements, and possibility of returning to the community after discharge. RESULTS The sample included a total of 1 028 470 patients (634 619 women [61.7%]; mean [SD] age, 78.23 [7.26] years): 473 017 patients admitted for stroke, 323 029 patients admitted for hip fracture, and 232 424 patients admitted for joint replacement. Individuals enrolled in MA plans were younger than TM beneficiaries (mean [SD] age, 76.96 [7.02] vs 77.95 [7.26] years for stroke, 79.92 [6.93] vs 80.85 [6.87] years for hip fracture, and 74.79 [6.58] vs 75.88 [6.80] years for joint replacement) and were more likely to be black (17 086 [25.5%] vs 54 648 [17.9%] beneficiaries) or Hispanic (14 496 [28.5%] vs 24 377 [8.3%] beneficiaries). The MA beneficiaries accounted for 21.8% (103 204 of 473 017) of admissions for stroke, 11.5% (37 160 of 323 029) of admissions for hip fracture, and 11.8% (27 314 of 232 424) of admissions for joint replacement. The MA beneficiaries had shorter mean lengths of stay than did TM beneficiaries for both stroke (0.11 day; 95% CI, −0.15 to −0.07 day; 1.15% shorter) and hip fracture (0.17 day; 95% CI, −0.21 to −0.13 day; 0.85% shorter). The MA beneficiaries also had higher possibilities of returning to the community than did TM beneficiaries, by 3.0% (95% CI, 2.6%-3.4%) for stroke and 5.0% (95% CI, 4.4%-5.6%) for hip fracture. The shorter length of stay and better ultimate outcomes were achieved without substantially compromising the intermediate functional improvements. Facility type (freestanding vs (continued) Key Points Question Do Medicare Advantage beneficiaries experience different care services and outcomes from inpatient rehabilitation facilities than traditional Medicare beneficiaries do? Findings In this multiyear crosssection...

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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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Quality of Care for White and Hispanic Medicare Advantage Enrollees in the United States and Puerto Rico

Cited by 41 publications

References 10 publications

Variation in process quality measures of diabetes care by region and institution in Japan during 2015–2016: An observational study of nationwide claims data

Variation in process quality measures of diabetes care by region and institution in Japan during 2015–2016: An observational study of nationwide claims data

Assessment of Differences in Inpatient Rehabilitation Services for Length of Stay and Health Outcomes Between US Medicare Advantage and Traditional Medicare Beneficiaries

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

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