Dive Brief:
- A new study by Brown University researchers suggests Medicare Advantage may not be meeting complex patients' healthcare needs. It found between 2010 and 2011 patients with high-cost care were more likely to switch from Medicare Advantage to traditional Medicare than visa-versa.
- Data from 36,000 Medicare beneficiaries, about 25% of whom had Medicare Advantage, was studied to see how many switched from one plan to the other.
- A big difference was seen in those needing complex care: 17% in nursing homes and 8% receiving home healthcare switched to Medicare versus 3% in both nursing homes and home healthcare recipients switching to Medicare Advantage.
Dive Insight:
The study authors reported the results were more pronounced in those enrolled in Medicare and Medicaid, which allows people to switch anytime and use more expensive care.
Some criticism regarding the study was expressed by several experts. Gretch Jacobson, associate director at the Kaiser Family Foundation's Program on Medicare Policy, wasn't sure why those needing more complex care were switching out of Medicare Advantage plans. She said it could be due to limited provider networks, unused extra benefits or prescription drug needs. However, she added most people stay with their chosen insurance plans. "Most people are not changing when they make an initial decision about their coverage, but this is an area that's ripe for more research," she told Reuters.
America's Health Insurance Plans representative Claire Krusing pointed out the study was limited to just one year and Medicare Advantage plans have since adopted changes.
CMS has been looking for ways to minimize the number of patients switching back to traditional Medicare by paying more to private plans for sicker patients and providing incentives to manage costs. However, Jack Hoadley, an analyst at Georgetown University's Health Policy Research Institute, told NPR the study suggests the incentives aren't effective.