Association of Medicare Advantage Penetration With Per Capita Spending,Emergency Department Visits,and Readmission Rates Among Fee-for-Service Medicare Beneficiaries With High Comorbidity Burden

Abstract

Rapid growth of Medicare Advantage (MA) plans has the potential to change clinical practice for both MA and fee-for-service (FFS) beneficiaries, particularly for high-need, high-cost beneficiaries with multiple chronic conditions or a costly single condition. We assessed whether MA growth from 2010 to 2017 spilled over to county-level per capita spending, emergency department visits, and readmission rates among FFS beneficiaries, and how much this varied by the comorbidity burden of the beneficiary. We also examined whether the association between MA growth and per capita spending in FFS varied in beneficiaries with specific chronic conditions. MA growth was associated with decreased FFS spending and emergency department visits only among beneficiaries with six or more chronic conditions. MA growth was associated with decreased FFS spending among beneficiaries with 11 of the 20 chronic conditions. This suggests that MA growth may drive improvements in efficiency of health care delivery for high-need, high-cost beneficiaries.

Keywords

Medicare fee-for-service Medicare Advantage spillover managed care health care costs emergency department health care delivery

Get full access to this article

View all access options for this article.

References

Baicker

Chernew

M. E.

Robbins

J. A.

(2013). The spillover effects of Medicare managed care: Medicare Advantage and hospital utilization. Journal of Health Economics, 32(6), 1289-1300. https://doi.org/10.1016/j.jhealeco.2013.09.005

Baicker

Robbins

J. A.

(2015). Medicare payments and system-level health-care use: The spillover effects of Medicare managed care. American Journal of Health Economics, 1(4), 399-431. https://doi.org/10.1162/AJHE_a_00024

Callison

(2016). Medicare managed care spillovers and treatment intensity. Health Economics, 25(7), 873-887. https://doi.org/10.1002/hec.3191

Centers for Medicare & Medicaid Services. (2012). Chronic conditions among Medicare beneficiaries: 2012 Chartbook edition. Author.

Chernew

Decicca

Town

(2008). Managed care and medical expenditures of Medicare beneficiaries. Journal of Health Economics, 27(6), 1451-1461. https://doi.org/10.1016/j.jhealeco.2008.07.014

Chronic Conditions Data Warehouse. (n.d.). CCW chronic condition algorithms. Centers for Medicare & Medicaid Services.

Colligan

E. M.

Pines

J. M.

Colantuoni

Howell

Wolff

J. L.

(2016). Risk factors for persistent frequent emergency department use in Medicare beneficiaries. Annals of Emergency Medicine, 67(6), 721-729. https://doi.org/10.1016/j.annemergmed.2016.01.033

Congressional Budget Office. (2012). Lessons from Medicare’s demonstration projects on disease management, care coordination, and value-based payment. Author.

Curto

Einav

Finkelstein

Levin

Bhattacharya

(2019). Health care spending and utilization in public and private Medicare. American Economic Journal: Applied Economics, 11(2), 302-332. https://doi.org/10.1257/app.20170295

10.

Geruso

Layton

(2019). Upcoding: Evidence from Medicare on squishy risk adjustment. Journal of Political Economy, 128(3), 984-1026. https://doi.org/10.1086/704756

11.

Henke

R. M.

Karaca

Gibson

T. B.

Cutler

Barrett

M. L.

Levit

Johann

Nicholas

L. H.

Wong

H. S.

(2018). Medicare Advantage and traditional Medicare hospitalization intensity and readmissions. Medical Care Research and Review, 75(4), 434-453. https://doi.org/10.1177/1077558717692103

12.

Henke

R. M.

Karaca

Gibson

T. B.

Cutler

White

Wong

H. S.

(2018). Medicare Advantage penetration and hospital costs before and after the Affordable Care Act. Medical Care, 56(4), 321-328. https://doi.org/10.1097/MLR.0000000000000885

13.

Huckfeldt

P. J.

Escarce

J. J.

Rabideau

Karaca-Mandic

Sood

(2017). Less intense postacute care, better outcomes for enrollees in Medicare Advantage than those in fee-for-service. Health Affairs (Millwood), 36(1), 91-100. https://doi.org/10.1377/hlthaff.2016.1027

14.

Johnson

Figueroa

J. F.

Zhou

Orav

E. J.

Jha

A. K.

(2016). Recent growth in Medicare Advantage enrollment associated with decreased fee-for-service spending in certain US counties. Health Affairs (Millwood), 35(9), 1707-1715. https://doi.org/10.1377/hlthaff.2015.1468

15.

Joynt

K. E.

Gawande

A. A.

Orav

E. J.

Jha

A. K.

(2013). Contribution of preventable acute care spending to total spending for high-cost Medicare patients. Journal of the American Medical Association, 309(24), 2572-2578. https://doi.org/10.1001/jama.2013.7103

16.

Langellier

B. A.

Park

(2020). Financial performance of Medicare Advantage contracts in 2014 and plan renewal, consolidation, and termination rates in the subsequent year. Medical Care, 58(8), 674-680. https://doi.org/10.1097/MLR.0000000000001314

17.

McWilliams

J. M.

Hsu

Newhouse

J. P.

(2012). New risk-adjustment system was associated with reduced favorable selection in Medicare advantage. Health Affairs (Millwood), 31(12), 2630-2640. https://doi.org/10.1377/hlthaff.2011.1344

18.

Medicare Payment Advisory Commission. (2015). Report to the Congress: Medicare payment policy. Author.

19.

Neuman

Jacobson

G. A.

(2018). Medicare Advantage checkup. New England Journal of Medicine, 379(22), 2163-2172. https://doi.org/10.1056/NEJMhpr1804089

20.

Newhouse

J. P.

Price

Hsu

McWilliams

J. M.

McGuire

T. G.

(2015). How much favorable selection is left in Medicare Advantage? American Journal of Health Economics, 1(1), 1-26. https://doi.org/10.1162/ajhe_a_00001

21.

Newhouse

J. P.

Price

McWilliams

J. M.

Hsu

Souza

Landon

B. E.

(2019). Adjusted mortality rates are lower for Medicare Advantage than traditional Medicare, but the rates converge over time. Health Affairs (Millwood), 38(4), 554-560. https://doi.org/10.1377/hlthaff.2018.05390

22.

Panagiotou

O. A.

Kumar

Gutman

Keohane

L. M.

Rivera-Hernandez

Rahman

Gozalo

P. L.

Mor

Trivedi

A. N.

(2019). Hospital readmission rates in Medicare Advantage and traditional Medicare: A retrospective population-based analysis. Annals of Internal Medicine, 171(2), 99-106. https://doi.org/10.7326/M18-1795

23.

Park

Figueroa

J. F.

Fishman

Coe

N. B.

(2020). Primary care utilization and expenditures in traditional Medicare and Medicare Advantage, 2007-2016. Journal of General Internal Medicine, 35(8), 2480-2481. https://doi.org/10.1007/s11606-020-05826-x

24.

Park

Fishman

White

Larson

E. B.

Coe

N. B.

(2019). Disease-specific plan switching between traditional Medicare and Medicare Advantage. Permanente Journal, 24, Article 19.059. https://doi.org/10.7812/TPP/19.059

25.

Park

Larson

E. B.

Fishman

White

Coe

N. B.

(in press). Differences in health care utilization, process of diabetes care, care satisfaction, and health status in patients with diabetes in Medicare Advantage vs. traditional Medicare. Medical Care.

26.

Park

White

Fishman

Larson

E. B.

Coe

N. B.

(2020). Health care utilization, care satisfaction, and health status for Medicare Advantage and traditional Medicare beneficiaries with and without Alzheimer disease and related dementias. JAMA Network Open, 3(3), Article e201809. https://doi.org/10.1001/jamanetworkopen.2020.1809

27.

Riley

G. F.

(2007). Long-term trends in the concentration of Medicare spending. Health Affairs (Millwood), 26(3), 808-816. https://doi.org/10.1377/hlthaff.26.3.808

28.

Shier

Ginsburg

Howell

Volland

Golden

(2013). Strong social support services, such as transportation and help for caregivers, can lead to lower health care use and costs. Health Affairs (Millwood), 32(3), 544-551. https://doi.org/10.1377/hlthaff.2012.0170

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.13 MB