Nancy Ochieng and Jeannie Fuglesten Biniek Follow @jeanniebin on
Twitter Published: Sep 16, 2022
The growing role of Medicare Advantage in the
Medicare program and the changing demographics of Medicare Advantage enrollees
have given rise to an interest in how well private plans serve their enrollees
relative to traditional Medicare. To answer this question, we build on a previous review of research by examining 62 studies
published since 2016 that compare Medicare Advantage and traditional Medicare
based on measures of beneficiary experience, affordability, service
utilization, and quality.
We found few differences between Medicare
Advantage and traditional Medicare that are supported by strong evidence or
have been replicated across multiple studies. Both Medicare Advantage and
traditional Medicare beneficiaries reported similar rates of satisfaction with
their care and overall measures of care coordination. Medicare Advantage
outperformed traditional Medicare on some measures, such as use of preventive
services, having a usual source of care, and lower hospital readmission rates.
However, traditional Medicare outperformed Medicare Advantage on other
measures, such as receiving care in the highest-rated hospitals for cancer care
or in the highest-quality skilled nursing facilities and home health agencies.
Additionally, a somewhat smaller share of traditional Medicare beneficiaries
than Medicare Advantage enrollees experienced a cost-related problem, mainly
due to lower rates of cost-related problems among traditional Medicare beneficiaries
with supplemental coverage. Several studies found lower use of post-acute care
among Medicare Advantage enrollees but were inconclusive as to whether that was
associated with better or worse outcomes. Findings related to the use of other
health care services, including hospital care and prescription drugs, and
condition-specific quality of care measures varied – likely due to differences
in data and methodology across studies.
When possible, we highlight findings for
specific subgroups of interest, such as beneficiaries from communities of
color, living in rural areas, or dually eligible for Medicare and Medicaid.
Notably, relatively few studies specifically examine these population
subgroups, so it is difficult to assess the strength of the findings or how
broadly they apply. For example, one study found that Black Medicare
beneficiaries had higher rates of potentially avoidable hospitalizations in
Medicare Advantage than in traditional Medicare. While important, we could not
identify additional analyses that compared the rate of potentially avoidable
hospitalizations between Medicare Advantage and traditional Medicare among
Hispanic and other beneficiaries of color, beneficiaries living in rural areas,
or beneficiaries dually eligible for Medicare and Medicaid. Additionally,
despite an increased focus on alternative payment models in Medicare, we only
identified two studies that differentiated traditional Medicare beneficiaries attributed
to accountable care organizations (ACOs) from traditional Medicare
beneficiaries not attributed to ACOs.
Our findings across all measures are
summarized below.
BENEFICIARY
EXPERIENCE
Satisfaction, access to care,
care coordination, and experience with prescription drugs: Beneficiaries in Medicare Advantage and
traditional Medicare reported similar rates of satisfaction with their care,
and similar experiences with wait times, finding a new provider, and overall
measures of care coordination. However, Medicare Advantage enrollees were more
likely to report having a usual source of care, receiving information during
care transitions, and having better experiences getting needed prescription
drugs.
Switching: Overall, there were low rates of
switching between Medicare Advantage and traditional Medicare, though a
slightly larger share of Medicare Advantage enrollees opted to switch from
Medicare Advantage to traditional Medicare than beneficiaries who switched from
traditional Medicare to Medicare Advantage. Additionally, rates of switching
from Medicare Advantage to traditional Medicare were relatively higher among
beneficiaries who are dually eligible for Medicare and Medicaid, beneficiaries
of color, beneficiaries in rural areas, and following the onset of a functional
impairment. Switching rates may be a proxy for dissatisfaction with current
coverage arrangements.
AFFORDABILITY
A somewhat smaller share of beneficiaries in
traditional Medicare with supplemental coverage than Medicare Advantage enrollees
reported having cost-related problems. Similar findings were observed among
Black beneficiaries, beneficiaries under the age of 65, and beneficiaries in
fair or poor self-assessed health. Beneficiaries in traditional Medicare with
no supplemental coverage had higher rates of cost-related problems than
beneficiaries enrolled in Medicare Advantage plans. Three studies examining
beneficiaries with high-needs, diabetes, or a mental illness found no
differences in affordability-related measures between Medicare Advantage and
traditional Medicare.
UTILIZATION
Preventive services: Medicare Advantage enrollees were more
likely than beneficiaries in traditional Medicare to receive preventive care
services, such as annual wellness visits and routine checkups, screenings, and
flu or pneumococcal vaccines, based on several studies, with similar findings
for people of color and beneficiaries under age 65.
Hospital Services: Differences in the use of hospital
services between people in Medicare Advantage and traditional Medicare varied
based on how hospital utilization is measured. Overall, there were generally no
differences in the aggregate number of hospital days or average length of stay
for common medical admissions, based on evidence from five studies. Four studies
found fewer hospital stays among Medicare Advantage enrollees compared to
traditional Medicare beneficiaries for at least some groups of beneficiaries.
Differences in the share of beneficiaries with at least one hospital stay
varied, with two studies finding no differences between Medicare Advantage and
traditional Medicare and two studies finding lower rates in Medicare Advantage.
No studies examined differences in hospital utilization between Medicare
Advantage and traditional Medicare by race and ethnicity or other demographics.
Post-Acute Care: Several studies reported lower rates of
skilled nursing facility (SNF), inpatient rehabilitation facility (IRF), and
home health use among Medicare Advantage enrollees, and shorter lengths of stay
in SNFs and IRFs for Medicare Advantage enrollees than traditional Medicare
beneficiaries. Across the seven studies that examined the relationship between
post-acute care use, home health use, and patient outcomes, studies generally
found lower hospital readmission rates among Medicare advantage users of SNFs
and lower hospitalization rates among Medicare Advantage users of home health,
but mixed results across other outcomes of care. None of these studies
presented results by race and ethnicity or other demographics.
Prescription Drugs: Findings on prescription drug use varied
depending on the measure of utilization and condition studied. Three studies
found that among specific groups – people with a mental illness, diabetes,
Alzheimer’s disease, and high-need beneficiaries (each studied separately) –
there were no differences in the use of prescription drugs between Medicare
Advantage and traditional Medicare beneficiaries. Two of these studies found
that the use of prescription drugs was higher for Medicare Advantage enrollees
than traditional Medicare beneficiaries without diabetes and without
Alzheimer’s disease. Conversely, another study found that Medicare Advantage
enrollees were less likely than traditional Medicare beneficiaries in
stand-alone prescription drug plans to fill at least one prescription for an opioid.
None of these studies stratified results by race and ethnicity or other
demographic groups.
Physician-administered drugs
(i.e., Part B drugs): A single study
examined the use of physician-administered drugs and found no difference
between Medicare Advantage enrollees and traditional Medicare beneficiaries in
the number of injectable drug procedures. Another study found that Medicare
Advantage enrollees were more likely than traditional Medicare beneficiaries to
receive low-cost Part B drugs in four clinical scenarios where similar or
equally effective drugs exist, suggesting that Medicare Advantage coverage may
be associated with more efficient prescribing of Part B drugs. These two
studies did not present results by race, ethnicity, or other demographics.
Other medical provider and
emergency department visits: Medicare Advantage enrollees had fewer medical provider
visits overall, but more primary care visits per person, based on four of the
six studies we reviewed that compared the number of provider visits between
beneficiaries enrolled in Medicare Advantage and traditional Medicare.
Emergency department (ED) use was generally similar among Medicare Advantage
and traditional Medicare beneficiaries overall, based on one study. A second
study that focused on beneficiaries in a single hospital-based delivery system
(Banner Health) found that Medicare Advantage enrollees had higher ED visit
rates than traditional Medicare attributed to an ACO and traditional Medicare
beneficiaries not attributed to an ACO. None of these studies presented results
by race, ethnicity, or other demographics.
QUALITY
Hospital Readmissions: Seven of the 12 studies comparing
hospital readmission rates found lower overall readmission rates among Medicare
Advantage enrollees than among traditional Medicare beneficiaries. However,
four studies that were limited to beneficiaries in a single hospital or
beneficiaries undergoing specific procedures, such as knee/hip replacements,
found no differences. One study that looked at readmission rates for people
with three chronic conditions (myocardial infarction, congestive heart failure,
and pneumonia) found higher readmission rates among Medicare Advantage
enrollees relative to beneficiaries in traditional Medicare. In two separate
studies, Black beneficiaries had higher readmission rates than White
beneficiaries in both Medicare Advantage and traditional Medicare.
Potentially avoidable
hospitalizations: One study found
that Black beneficiaries had higher rates of potentially avoidable hospitalizations
for ambulatory care sensitive conditions (ACSCs) in Medicare Advantage than in
traditional Medicare. Another study examined rates of hospitalization for
ambulatory care sensitive conditions overall and by clinical condition, finding
that traditional Medicare beneficiaries were hospitalized more often than
Medicare Advantage enrollees for ACSCs; however, this study did not account for
differences in the characteristics of Medicare Advantage enrollees and
traditional Medicare beneficiaries.
Quality of facility or provider: Five of six studies we reviewed that looked at
quality ratings of health care facilities and providers used by Medicare
Advantage enrollees and traditional Medicare beneficiaries found that Medicare
Advantage enrollees were less likely than traditional Medicare beneficiaries to
receive care in the highest-or lowest-rated hospitals overall or in the
highest-rated hospitals for cancer care, skilled nursing facilities (SNFs), and
home health agencies. A sixth study examined 18 facility-level quality measures
in long-stay nursing homes (i.e., nursing homes) and short-stay nursing homes
(i.e., SNFs), finding no differences between Medicare Advantage and traditional
Medicare for ten of the measures. However, the remaining eight measures had
mixed findings, with Medicare Advantage enrollees having lower risk of
antipsychotic drug use while traditional Medicare beneficiaries having lower
risk of moderate to severe pain and urinary incontinence.
Disease management (heart
disease and diabetes): Findings
on disease management varied by condition and quality measure. Among
beneficiaries with heart disease, Medicare Advantage enrollees were more likely
than those in traditional Medicare to receive guideline-recommended therapies
in ambulatory settings, but there were no differences reported in inpatient
settings. Additionally, among people with diabetes, Medicare Advantage
enrollees were more likely than beneficiaries in traditional Medicare to be
prescribed guideline-recommended therapy, use medication for their condition,
and perform better on clinical care measures such as diabetic eye exam
screening; however, there were no differences in blood sugar control, insulin
use, or receipt of blood diabetes tests between Medicare Advantage enrollees and
traditional Medicare beneficiaries.
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