Recent studies comparing Medicare Advantage to fee-for-service Medicare found disparities in physician networks, neighborhood impact on healthcare utilization, health-related social needs among beneficiaries, demographic differences in plan selection, challenges with the star rating system, growth of “look-alike” plans, narrow networks for psychiatrists, and lower prescription rates of high-risk medications in Medicare Advantage. These insights can guide policy improvements and healthcare provider strategies.
Recent research has shed light on various aspects of Medicare Advantage in comparison to fee-for-service Medicare. Below are summaries of eight recent studies reported by Becker since June 30:
1. Physician Network Disparities: A study published in JAMA Health Forum revealed that physicians serving more dually eligible patients (those eligible for both Medicare and Medicaid) and patients with higher risk scores are less likely to be included in Medicare Advantage networks.
2. Neighborhood Impact on Healthcare Utilization: The American Journal of Managed Care study found that an individual’s neighborhood can influence their healthcare utilization, particularly in the Medicare population. Older adults (65+) in disadvantaged neighborhoods had a higher risk of using high-cost medical care, whereas younger commercially insured adults did not exhibit the same risk.
3. Health-Related Social Needs Among Beneficiaries: A study in Health Affairs, based on a survey of over 300,000 Humana Medicare Advantage enrollees, found that almost half of the beneficiaries reported having at least one health-related social need. Those dually eligible for Medicare and Medicaid were more likely to have such needs, with 80 percent reporting at least one of seven identified needs.
4. Demographic and Socioeconomic Differences in Plan Selection: Researchers from Harvard Medical School and Inovalon identified several demographic and socioeconomic differences between individuals who opt for traditional Medicare coverage versus Medicare Advantage plans before turning 65 and those with commercial insurance.
5. Challenges with Medicare Advantage Star Rating System: A report from the Urban Institute indicated that the Medicare Advantage Star rating system and its quality bonus payment program are not achieving their primary goals of aiding beneficiaries in selecting a plan and encouraging payers to enhance plan quality.
6. Growth of “Look-Alike” Dual Eligible Medicare Advantage Plans: The study published in Health Affairs observed a significant increase in “look-alike” dual-eligible Medicare Advantage plans from 2013 to 2020. These plans primarily enroll people eligible for both Medicare and Medicaid but are not regulated as D-SNP plans.
7. Narrow Networks for Psychiatrists in Medicare Advantage: Health Affairs reported that many Medicare Advantage plans have limited networks for psychiatrists compared to Medicaid managed care and ACA plans. Approximately two-thirds of psychiatry networks in Medicare Advantage include fewer than 25 percent of psychiatry providers in the plan’s area.
8. Prescription of High-Risk Medications: According to a study published in JAMA Health Forum, Medicare Advantage members are less likely to be prescribed high-risk medications compared to their counterparts in fee-for-service Medicare.
These studies offer valuable insights into the intricacies and disparities within Medicare Advantage and provide essential information for policymakers and healthcare providers to consider for improving the program.