The Roles of Cost and Quality Information in Medicare Advantage Plan Enrollment Decisions: an Observational Study

Reid, Rachel O.; Deb, Partha; Howell, Benjamin L.; Conway, Patrick H.; Shrank, William H.

doi:10.1007/s11606-015-3467-3

Cited by 20 publications

(29 citation statements)

References 22 publications

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“…Which insurance plans seniors choose has important ramifications for their access to care, out-of-pocket spending, and Medicare costs. In a recent article by Reid et al enrollment decisions in Medicare plans were predicted predominantly by the MA plan's market share (35%), premium and out-of-pocket spending (25% and 12%, respectively), and star ratings (14%; Reid, Deb, Howell, Conway, & Shrank, 2016; Trivedi, 2016). …”

Section: Discussionmentioning

confidence: 99%

Favorable Risk Selection in Medicare Advantage: Trends in Mortality and Plan Exits Among Nursing Home Beneficiaries

et al. 2016

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The 2003 Medicare Modernization Act (MMA) increased payments to Medicare Advantage plans and instituted a new risk-adjustment payment model to reduce plans' incentives to enroll healthier Medicare beneficiaries and avoid those with higher costs. Whether the MMA reduced risk selection remains debatable. This study uses mortality differences, nursing home utilization, and switch rates to assess whether the MMA successfully decreased risk selection from 2000 to 2012. We found no decrease in the mortality difference or adjusted difference in nursing home use between plan beneficiaries pre- and post the MMA. Among beneficiaries with nursing home use, disenrollment from Medicare Advantage plans declined from 20% to 12%, but it remained 6 times higher than the switch rate from traditional Medicare to Medicare Advantage. These findings suggest that the MMA was not associated with reductions in favorable risk selection, as measured by mortality, nursing home use, and switch rates.

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Section: Discussionmentioning

confidence: 99%

Favorable Risk Selection in Medicare Advantage: Trends in Mortality and Plan Exits Among Nursing Home Beneficiaries

et al. 2016

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“…One notable study focused on associations between perceptions of care quality and survival for colorectal cancer patients 25 , and found that patients reporting they were "completely satisfied" with their care demonstrated a significantly lower mortality, after controlling for clinical and sociodemographic characteristics. Four focused on quality of the health plan [26][27][28][29] , and all investigated the variability of patient quality ratings across Medicare Advantage (MA) plans and subsequent impact on initial patient enrollment and changes in enrollment. A 2006 study assessed variations in care quality (based on Healthcare Effectiveness Data and Information Set (HEDIS) measures) across racial/ethnic groups, and determined that only 1 plan out of 151 assessed achieved both high quality and low disparity on more than 1 measure 26 .…”

Section: Patient Perceptions Of Care Qualitymentioning

confidence: 99%

“…Xu and colleagues 29 investigated whether MA contract characteristics are associated with quality of care through star ratings and determined that nonprofit (vs. for-profit), larger, and older MA contracts were more likely to receive higher star ratings. An additional study assessed associations between MA plan attributes (cost, quality, and benefits) and beneficiary enrollment, finding that preference for higher quality and lower-cost MA plans with diminishing differences at higher star ratings of 4 and 5 27 .…”

Section: Patient Perceptions Of Care Qualitymentioning

confidence: 99%

Patient experiences of cancer care: scoping review, future directions, and introduction of a new data resource: Surveillance Epidemiology and End Results-Consumer Assessment of Healthcare Providers and Systems (SEER-CAHPS)

Mollica¹,

Lines²,

Halpern³

et al. 2017

Patient Experience Journal

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The shift towards providing high value cancer care has placed increasing importance on patient experiences. This scoping review summarizes patient experience literature, highlights research gaps, and provides future research directions. We then introduce a new resource that links the National Cancer Institute's Surveillance Epidemiology and End Results (SEER) program with the Centers for Medicare and Medicaid Services Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey and longitudinal medical claims data. We conducted a scoping review to identify relevant research within the Medicare CAHPS domain that examine factors associated with patient-reported experiences with their cancer care. Gaps indicate a need for population-based research to explore relationships between cancer patient experiences, healthcare utilization, and subsequent patient outcomes. SEER-CAHPS, a publicly accessible data resource, may assist in addressing these gaps by linking cancer registry (SEER), survey data reported by Medicare beneficiaries (CAHPS), and Medicare claims, providing unique insight into quality of care. Linked data include 231,089 surveys from patients with a cancer diagnosis, and 4,236,529 surveys from patients without a cancer diagnosis. Results indicate substantial gaps in our knowledge of patient experiences and the need for additional resources. SEER-CAHPS links direct patient feedback with cancer registry and Medicare claims, making it an important source of information on experiences and healthcare utilization. Increasing recognition of the importance of patient-centeredness points to the need for population-based studies. Findings from SEER-CAHPS will inform initiatives to improve care delivery.

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“…Surveys have suggested that star ratings play little role in seniors’ plan choices [ 6 , 7 ]. At the same time, quantitative empirical studies have indicated that higher star ratings were in fact associated with higher MAPD enrollment [ 4 , 8 , 9 ]. However, these studies all used cross-sectional study designs and thus could not establish a causal link between ratings and increased enrollment.…”

Section: Introductionmentioning

confidence: 99%

Impact of Medicare Advantage Prescription Drug Plan Star Ratings on Enrollment before and after Implementation of Quality-Related Bonus Payments in 2012

Doshi

2016

PLoS ONE

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ObjectiveSince 2007, the Centers for Medicare and Medicaid Services have published 5-star quality rating measures to aid consumers in choosing Medicare Advantage Prescription Drug Plans (MAPDs). We examined the impact of these star ratings on Medicare Advantage Prescription Drug (MAPD) enrollment before and after 2012, when star ratings became tied to bonus payments for MAPDs that could be used to improve plan benefits and/or reduce premiums in the subsequent year.MethodsA longitudinal design and multivariable hybrid models were used to assess whether star ratings had a direct impact on concurrent year MAPD contract enrollment (by influencing beneficiary choice) and/or an indirect impact on subsequent year MAPD contract enrollment (because ratings were linked to bonus payments). The main analysis was based on contract-year level data from 2009–2015. We compared effects of star ratings in the pre-bonus payment period (2009–2011) and post-bonus payment period (2012–2015). Extensive sensitivity analyses varied the analytic techniques, unit of analysis, and sample inclusion criteria. Similar analyses were conducted separately using stand-alone PDP contract-year data; since PDPs were not eligible for bonus payments, they served as an external comparison group.ResultThe main analysis included 3,866 MAPD contract-years. A change of star rating had no statistically significant effect on concurrent year enrollment in any of the pre-, post-, or pre-post combined periods. On the other hand, star rating increase was associated with a statistically significant increase in the subsequent year enrollment (a 1-star increase associated with +11,337 enrollees, p<0.001) in the post-bonus payment period but had a very small and statistically non-significant effect on subsequent year enrollment in the pre-bonus payment period. Further, the difference in effects on subsequent year enrollment was statistically significant between the pre- and post-periods (p = 0.011). Sensitivity analyses indicated that the findings were robust. No statistically significant effect of star ratings was found on concurrent or subsequent year enrollment in the pre- or post-period in the external comparison group of stand-alone PDP contracts.ConclusionStar ratings had no direct impact on concurrent year MAPD enrollment before or after the introduction of bonus payments tied to star ratings. However, after the introduction of these bonus payments, MAPD star ratings had a significant indirect impact of increasing subsequent year enrollment, likely via the reinvestment of bonuses to provide lower premiums and/or additional member benefits in the following year.

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The Roles of Cost and Quality Information in Medicare Advantage Plan Enrollment Decisions: an Observational Study

Cited by 20 publications

References 22 publications

Favorable Risk Selection in Medicare Advantage: Trends in Mortality and Plan Exits Among Nursing Home Beneficiaries

Favorable Risk Selection in Medicare Advantage: Trends in Mortality and Plan Exits Among Nursing Home Beneficiaries

Patient experiences of cancer care: scoping review, future directions, and introduction of a new data resource: Surveillance Epidemiology and End Results-Consumer Assessment of Healthcare Providers and Systems (SEER-CAHPS)

Impact of Medicare Advantage Prescription Drug Plan Star Ratings on Enrollment before and after Implementation of Quality-Related Bonus Payments in 2012

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