Do Medicare Advantage Plans Respond to Payment Changes? A Look at the Data from 2009 to 2014.

Issue: Medicare Advantage (MA) enrollment has grown significantly since 2009, despite legislation that reduced what Medicare pays these plans to provide care to enrollees. MA payments, on average, now approach parity with costs in traditional Medicare. Goal: Examine changes in per enrollee costs between 2009 and 2014 to better understand how MA plans have continued to thrive even as payments decreased. Methods: Analysis of Medicare data on MA plan bids, net of rebates. Findings: While spending per beneficiary in traditional Medicare rose 5.0 percent between 2009 and 2014, MA payment benchmarks rose 1.5 percent and payment to plans decreased by 0.7 percent. Plans' expected per enrollee costs grew 2.6 percent. Plans where payment rates decreased generally had slower growth in their expected costs. HMOs, which saw their payments decline the most, had the slowest expected cost growth. Conclusions: In general, MA plans responded to lower payment by containing costs. By preserving most of the margin between Medicare payments and their bids in the form of rebates, they could continue to offer additional benefits to attract enrollees. The magnitude of this response varied by geographic area and plan type. Despite this slower growth in expected per enrollee costs, greater efficiencies by MA plans may still be achievable.

Medicare Advantage Enrollment Update 2017.

Purpose: The RUPRI Center for Rural Health Policy Analysis reports annually on rural beneficiary enrollment in Medicare Advantage (MA) plans, noting any trends or new developments evident in the data. These reports are based on data through March of each year, capturing results of open enrollment periods. Key Findings: (1) Nationally, 1 in 3 Medicare beneficiaries is enrolled in an MA plan. In non-metropolitan areas, nearly 1 in 4 (23.5 percent) beneficiaries is enrolled in an MA plan. (2) Enrollment in MA plans, measured either as an overall count or as a proportion of eligible Medicare beneficiaries, has increased in both metropolitan and non-metropolitan populations since 2004. (3) Between 2015 and 2017, the proportion of non-metropolitan Medicare-eligible beneficiaries enrolled in local preferred provider organization (PPO), regional PPO, and "other" plans (including cost, health care pre-payment [HCPP], medical savings account [MSA] and demonstration plans) remained relatively steady. During the same period, the proportion of Medicare-eligible beneficiaries enrolled in health maintenance organization (HMO) plans increased slightly (from 28.5 percent in 2015 to 29.8 percent in 2017) while the proportion enrolled in private fee-for-service (PFFS) plans decreased slightly (from 5.6 percent in 2015 to 3.8 percent in 2017).

2015: Rural Medicare Advantage Enrollment Update.

Key Findings. (1) Rural enrollment in Medicare Advantage (MA) and other prepaid plans increased by 6.8 percent between March 2014 and March 2015 to 2.1 million members, or 21.2 percent of all rural residents eligible for Medicare. This compares to a national enrollment in MA and other prepaid plans of 31.1 percent (16.7 million) of enrollees. (2) Rural enrollment in Health Maintenance Organization (HMO) plans (including point-of-service, or POS, plans), Preferred Provider Organization (PP0) plans, and other pre-paid plans (including Medicare Cost and Program of All-Inclusive Care for the Elderly Plans) all increased by 5-13 percent. (3) Enrollment in private fee-for-service (PFFS) plans continued to decline (decreasing nationally by 15.8 percent and 12.1 percent in rural counties over the period March 2014-2015). Only eight states showed an increase in PFFS plan enrollment. Five states experienced decreases of 50 percent or more. (4) The five states with the highest percentages of rural beneficiaries enrolled in a Medicare Advantage plan are Minnesota (51.8 percent), Hawaii (39.4 percent), Pennsylvania (36.2 percent), Wisconsin (35.5 percent), and New York (31.5 percent).

Medicare Advantage update: benefits, enrollment, and payments after the ACA.

In 2012, the Medicare program paid private health plans $136 billion to cover about 13 million beneficiaries who received Part A and B benefits through the Medicare Advantage (MA) program rather than traditional fee-for-service (FFS) Medicare. Private plans have been a part of the program since the 1970s. Debate about the policy goals--Should they cost less per beneficiary than FFS Medicare? Should they be available to all beneficiaries? Should they be able to offer additional benefits?--has long accompanied Medicare's private plan option.This debate is reflected in the history of Medicare payment policy,and policy decisions over the years have affected plans' willingness to participate and beneficiaries' enrollment at different periods of the program. Recently, evidence that the Medicare program was paying more per beneficiary in MA relative to what would have been spent under FFS Medicare prompted policymakers to reduce MA payments in the Patient Protection and Affordable Care Act of 2010 (ACA). So far, plans continue to participate in MA and enrollment continues to grow, but payment reductions in 2012 through 2014 have been partially offset by payments made to plans through the quality bonus payment demonstration.This brief contains recent data on plan enrollment, availability, and benefits and discusses MA plan payment policy, including changes to MA payment made in the ACA and their actual and projected effects.

June 2012: rural MA enrollment and premium update.

Key Data Findings. (1) Rural Medicare Advantage (MA) enrollment grew to over 1.7 million in June 2012 (17% of eligible beneficiaries), while total MA enrollment grew to nearly 13.4 million (27% of eligible beneficiaries). (2) Rural preferred provider organization (PPO) and health maintenance organization (HMO) enrollment grew to over 840 thousand (48% of the market) and 532 thousand (31% of the market), respectively, while private fee-for-service (PFFS) enrollment fell to 230 thousand in rural areas (13% of the market). (3) Rural MA enrollment varies across the country with concentrations of enrollment on the West Coast, the Great Lakes, and the Northeast regions of the United States. (4) The average monthly weighted premium for rural MA plans with prescription drugs fell in 2012 to $48 from $52 in 2011, but it remains significantly higher than the urban average which also fell during the same time from $38 to $34. (5) Zero premium plans are available to 73% of rural MA beneficiaries and to 95% of urban beneficiaries; however, only 48% of rural beneficiaries that have this option choose these plans compared to 63% of urban beneficiaries. The resulting average non-zero premium was $72 in rural areas in 2012, while the average non-zero premium in urban areas was $81. (6) Roughly a third (35%) of rural MA beneficiaries receive their MA coverage including prescription drugs without having to pay a premium, however this is significantly lower than 60% of urban beneficiaries that do not have to pay a premium.

March 2013: Medicare Advantage update.

Key Data Findings. (1) From March 2012 to March 2013, rural enrollment in Medicare Advantage (MA) and other prepaid plans increased by over 200,000 enrollees, to more than 1.9 million. (2) Preferred provider organization (PPO) plan enrollment increased to nearly one million enrollees, accounting for more than 51% of the rural MA market (up from 48% in March 2012). (3) Health maintenance organization (HMO) enrollment continued to grow in 2013, with over 31% of the rural MA market, while private fee-for-service (PFFS) plan enrollment decreased to less than 10% of market share. (4) Despite recent changes to MA payment, rural MA enrollment continues to increase.

The effect of a PPO pay-for-performance program on patients with diabetes.

OBJECTIVES: To investigate the effectiveness of a pay-for-performance program (P4P) to increase the receipt of quality care and to decrease hospitalization rates among patients with diabetes mellitus. STUDY DESIGN: Longitudinal study of patients with diabetes enrolled in a preferred provider organization (PPO) between January 1, 1999, and December 31, 2006. METHODS: We used multivariate analyses to assess the effect of seeing P4P-participating physicians on the receipt of quality care (ie, glycosylated hemoglobin and low-density lipoprotein cholesterol testing) and on hospitalization rates, controlling for patient characteristics. RESULTS: Patients with diabetes who saw P4P-participating physicians were more likely to receive quality care than those who did not (odds ratio, 1.16; 95% confidence interval, 1.11-1.22; P <.001). Patients with diabetes who received quality care were less likely to be hospitalized than those who did not (incident rate ratio, 0.80; 95% confidence interval, 0.80-0.85; P <.001). During 1 year, there was no difference in hospitalization rates between patients with diabetes who saw P4P-participating physicians versus those who did not. However, patients with diabetes who saw P4P-participating physicians in 3 consecutive years were less likely to be hospitalized than those who did not (incident rate ratio, 0.75; 95% confidence interval, 0.61-0.93; P <.01). CONCLUSIONS: A P4P can significantly increase the receipt of quality care and decrease hospitalization rates among patients with diabetes in a PPO setting. Although it is possible that the differences observed between P4P-participating physicians and non-P4P-participating physicians were due to selection bias, we found no significant difference in the receipt of quality care between patients with diabetes who saw new P4P-participating physicians versus non-P4P-participating physicians during the baseline year. Further research should focus on defining the effect of P4Ps on intermediate outcomes such as glycosylated hemoglobin and low-density lipoprotein cholesterol levels.

Rural enrollment in Medicare Advantage growing rapidly in 2007, especially in private fee-for-service plans.

UNLABELLED: Enrollment in Medicare Advantage (MA) plans has more than tripled since the inception of the MA program at the beginning of 2006. However, rural enrollment remains well below urban enrollment as a percentage of the eligible population. This policy brief provides findings about enrollment in the newly designed MA program in rural and urban areas across the United States and updates early findings from analysis of the Medicare+Choice/ MA program presented in previous RUPRI Center policy briefs. KEY FINDINGS: As of June 5, 2007 (date of release by CMS), (1) Over 780,000 rural Medicare beneficiaries were enrolled in an MA plan, an increase of 50% since November 2006, and a 222% increase since 2005. (2) Despite significant growth in MA plans, only 8.6% of rural persons were enrolled in MA plans in June 2007, compared to 21.7% of urban persons. (3) Over half (55%) of rural persons enrolled in MA or prepaid plans were in private fee-for-service (PFFS) plans, compared to only 14% of urban persons. (4) PFFS enrollment in rural areas in June 2007 was concentrated in several PFFS plans, with almost 90% of rural persons enrolled in plans run by seven organizations serving about 2,000 counties in the United States.

Rural enrollment in Medicare advantage is concentrated in private fee-for-service plans.

Enrollment in Medicare Advantage (MA) plans more than doubled in rural areas in 2006, the first year of the MA program. However, rural enrollment remains well below urban enrollment as a percentage of the eligible population. This policy brief provides findings about enrollment in the newly designed MA program in rural and urban areas across the United States and updates previous findings published in RUPRI Center policy briefs. Analysis of rural-urban differences in costs to beneficiaries that compares type of plan will be released in a policy brief in June 2007.

Update on rural enrollment in Medicare Advantage growth continues.

Enrollment in Medicare Advantage (MA) plans in rural areas grew more than 50% in the first three quarters of 2007 and has more than tripled since the inception of the MA program at the beginning of 2006. However, rural enrollment remains well below urban enrollment as a percentage of the eligible population. This brief updates early findings from analysis of the Medicare+Choice/MA program presented in previous RUPRI Center policy briefs.

Análisis de políticas públicas y salud, a propósito de la reforma sectorial sanitaria / Public policies analysis and health, with regard to the health sector reform

El presente ensayo considera una perspectiva de análisis e investigación de políticas públicas y recomienda su aplicación en el estudio de las reformas en salud. Se exponen algunas ideas sobre formulación de políticas públicas y salud y algunos aspectos metodológicos que involucran en la investigación a quienes toman las decisiones, así como a los diversos actores que intervienen en el proceso de la política. La idea central apunta a encontrar puentes entre investigadores y tomadores de decisión, la mayoría de las veces divorciados en sus propósitos

La unidad de pago por capitación del sistema de seguridad social en salud, 1996-2005 / The unit of capitation payment of the health social security system, 1996-2005

La unidad de pago por capitación (UPC) es la prima del seguro en el Sistema de Seguridad Social en Salud de Colombia. El análisis de su comportamiento es de suma importancia por sus efectos sobre la capacidad del sistema de lograr sus objetivos en cuanto al estado de salud de la población, el acceso a los servicios y su sostenibilidad financiera. En el caso del régimen contributivo, la UPC ha estado asociada a la dinámica de la compensación entre las cotizaciones y los recursos necesarios para financiar la población a cargo de las EPS, con pocas consideraciones sobre el costo del Plan Obligatorio de Salud (POS). En el caso del régimen subsidiado, se evidencia una tendencia a la igualación de ingresos y gastos, aunque se reconocen presiones sobre la sostenibilidad, resultado de la disminución del ritmo de crecimiento de las fuentes de financiación y el incremento en la demanda por atenciones costosas

Preferred provider organizations and Medicare: is there an advantage?

A key component of the new Medicare reform law is an overhaul of Medicare managed care, including a strong emphasis on recruiting private plans--especially preferred provider organizations (PPOs)--to participate in the new Medicare Advantage program. Citing the popularity of PPOs for privately insured Americans, proponents have touted PPOs as critical to injecting more and better competition into Medicare. This study, based on findings from the Center for Studying Health System Change's (HSC) site visits to 12 nationally representative communities, explores the reasons for the strong growth in commercial PPO enrollment and examines whether PPOs--as currently structured--can add value to Medicare. The available evidence suggests that the PPO model will face challenges in achieving the policy goals set forth in the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA), including increasing benefits, improving quality and slowing cost growth.