Increased Medicare Advantage Costs Do Not Seem to Promote Better Health

Medicare Advantage members and traditional Medicare members visit hospitals and emergency departments at the same frequency, even though privatized members receive more health care management services, according to a new report.

Thirty-four percent of traditional Medicare and Medicare Advantage people age 65 and over attended the emergency room during the two-year period from 2016 to 2018. for For example, according to the analysis published Commonwealth Foundation Thursday

Hospital admission rates were also similar, with 28% of Medicare Advantage members and 27% of Traditional Medicare members visiting a hospital during those two years.

The researchers relied on data from a 2018 survey of current Medicare beneficiaries and from this year’s Commonwealth Foundation survey. Researchers have separately assessed information about beneficiaries eligible for both Medicare and Medicaid through plans with special needs when the sample size was sufficient.

The similarity in patient outcomes raises the question of why Medicare Advantage plans are costing the government more than Medicare fees, especially as the number of people enrolled in privatized healthcare programs grows, said Gretchen Jacobson, the Commonwealth Foundation’s vice president of Medicare and author of the report. …

By 2025, half of all eligible recipients are expected to be enrolled in Medicare Advantage. Brokers and agents can get great compensation for registering seniors in Medicare Advantage than Medicare additive plans what pair with Part A and Part B, creating financial incentives for Medicare Advantage recommendations, under a separate Commonwealth Fund. study published on Tuesday.

“How valuable are these additional services if the results are the same?” – said Jacobson. “It’s really important for government and policymakers to appreciate this, given that Medicare Advantage plans are paying more right now than what it would cost to provide the same care to people in traditional Medicare.”

In addition to nearly different patient outcomes, the researchers found that people who participated in both programs had comparable rates of chronic conditions and that they were defined by similar racial, ethnic, and economic characteristics, excluding participants in the plan with special needs.

The similarity between the two enrolled groups represents a historic change for a privatized healthcare program.

Back in 2015, Medicare Advantage members were younger and included a higher proportion of racial and ethnic minorities and low-income people than traditional Medicare, according to a separate report. a Commonwealth Foundation report released last year. This study found that beneficiaries of private Medicare plans also suffered from more complex needs, but the analysis did not separate members with special needs from other Medicare Advantage members.

As the program has evolved, the patient gap has leveled off between Medicare Advantage and Medicare with a pay-for-service, with 41% of traditional Medicare participants having at least three chronic conditions, compared with 43% of Medicare Advantage participants. The prevalence of arthritis, cancer, diabetes, and depression is almost the same among traditional Medicare and Medicare Advantage members.

The new study did not take into account the severity of these conditions. Previous analyzes have shown that people in Medicare Advantage plans consume fewer services after adjusting for health conditions. offering this is population ailments are No as seriously compared to the population that pays for services. According to 2019 data, Medicare Advantage members with diabetes, asthma, breast cancer, or prostate cancer had lower spending rates than Medicare paid-for-service members with the same conditions. Research by the Kaiser Family Foundation

“We have indeed seen an expansion of Medicare Advantage plans across the country since [Affordable Care Act], including an increase in the number of companies offering Medicare Advantage plans, as well as expansion in many parts of the country, Jacobson said. “It can help take into account the alignment of patient populations.”

However, the patient mix for dual eligibility and special needs plans was different from both pay-for-service and Medicare Advantage-only plans.

Dual-eligible people enrolled in Medicare Advantage were significantly more likely to suffer from at least three chronic conditions than people enrolled in other programs, with 43% reporting at least three chronic conditions and 50% saying that they have been diagnosed with at least six chronic conditions. …

Special needs plan beneficiaries were also more than twice as likely to identify as black and three times more likely to identify as Hispanic than Medicare Advantage or traditional Medicare members. These populations are statistically more likely be poor and in poorer health than white people. White people are also less likely to participate in special needs programs.

Special Needs Medicare Advantage holders reach a “very vulnerable population,” Jacobson said. “It really draws attention to the fact that plans for people with special needs need a closer look, perhaps from a different policy perspective, because they serve a population in dire need. They can be the focus of equality policies. ”

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