The higher cost Medicare Advantage plan is not linked to better quality healthcare for the elderly

According to a new study from the RAND Corporation, enrolling in a higher-cost Medicare Advantage plan may not ensure better quality health care for seniors.

Looking at 15 different quality measures across large representative samples of people enrolled in Medicare Advantage plans in 2016 and 2017, the researchers found that plans that charged a higher monthly premium provided slightly better care on average than non-premium plans. monthly.

Quality varied substantially within each premium cost range studied, with high quality care observed across a number of plans in each cost range. More than 700 Medicare Advantage plans were part of the analysis.

The results are published in the latest edition of JAMA Health Forum.

Paying higher premiums is not required to receive high-quality care from a Medicare Advantage plan. Seniors should consider metrics other than premium costs alone when looking for a Medicare Advantage plan that offers high-quality care, including direct measures of quality, such as star ratings. “

Amelia M. Haviland, lead author of the study, professor of statistics and public policy at Carnegie Mellon University and adjunct statistics to the RAND

The costs of healthcare are a concern for both consumers and policy makers. People enrolled in Medicare Advantage plans report that pricing measures such as premium costs and co-payment are their primary consideration when choosing a plan.

To examine the link between premium cost and quality, RAND researchers looked at information about the care provided to people enrolled in Medicare Advantage plans. About 40% of subscribers had plans with no monthly premium, while 6% had plans with a monthly premium over $ 120.

Medicare Advantage plans provide coverage for hospital and medical services like the traditional Medicare paid rate, but they typically also offer additional services such as dental and eyewear coverage. In exchange for additional services and lower co-payments, members are limited to network providers. More than a third of Medicare enrollees choose Medicare Advantage plans.

The information used to measure the quality of care by Medicare Advantage plans included clinical quality measures based on administrative information such as medical records involving over 2 million subscribers. These quality measures included elements such as whether patients received recommended cancer screenings, whether high blood pressure was controlled, and whether diabetes was treated adequately.

The analysis also looked at surveys of over 168,000 randomly sampled plan participants who were asked about their experiences with health care, prescription drug coverage, and their plan. These measures included the ability to receive treatment, the ability to receive treatment quickly and obtain the necessary medications.

In most measures, people enrolled in the two tiers of the higher-premium plan reported on average similar or slightly better experiences than those enrolled in the lower-premium tiers. For example, people enrolled in the higher premium tiers were more likely to receive annual flu shots.

However, on the one hand, low-cost plans offered better care. People enrolled in lower tier plans received better osteoporosis care on average than their peers enrolled in higher tier plans.

“Because many high and low quality plans were found in each of the premium tiers we studied, the cost of the premium is a poor indicator for assessing the quality of a Medicare Advantage plan,” said Haviland. “Making plan quality information more accessible and salient to consumers is a key to reducing consumer costs while improving quality.”

Support for the study was provided by the Federal Centers for Medicare and Medicaid Services. Other authors of the study are Sai Ma from Humana, and David J. Klein, Nathan Orr, and Marc N. Elliott, all from RAND.


Journal reference:

Haviland, AM, et al. (2022) Association of Medicare Advantage Awards with Quality and Patient Experience Measures. JAMA Health Forum.

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