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Beneficiary Experience, Affordability, Utilization, and Quality in Medicare Advantage and Traditional Medicare: A Review of the Literature

The rising function of Medicare Benefit within the Medicare program and the altering demographics of Medicare Benefit enrollees have given rise to an curiosity in how effectively non-public plans serve their enrollees relative to conventional Medicare. To reply this query, we construct on a earlier evaluate of analysis by analyzing 62 research printed since 2016 that examine Medicare Benefit and conventional Medicare based mostly on measures of beneficiary expertise, affordability, service utilization, and high quality.

We discovered few variations between Medicare Benefit and conventional Medicare which can be supported by robust proof or have been replicated throughout a number of research. Each Medicare Benefit and conventional Medicare beneficiaries reported related charges of satisfaction with their care and general measures of care coordination. Medicare Benefit outperformed conventional Medicare on some measures, resembling use of preventive providers, having a normal supply of care, and decrease hospital readmission charges. Nonetheless, conventional Medicare outperformed Medicare Benefit on different measures, resembling receiving care within the highest-rated hospitals for most cancers care or within the highest-quality expert nursing amenities and residential well being companies. Moreover, a considerably smaller share of conventional Medicare beneficiaries than Medicare Benefit enrollees skilled a cost-related drawback, primarily resulting from decrease charges of cost-related issues amongst conventional Medicare beneficiaries with supplemental protection. A number of research discovered decrease use of post-acute care amongst Medicare Benefit enrollees however had been inconclusive as as to whether that was related to higher or worse outcomes. Findings associated to using different well being care providers, together with hospital care and prescribed drugs, and condition-specific high quality of care measures diverse – probably resulting from variations in information and methodology throughout research.

When attainable, we spotlight findings for particular subgroups of curiosity, resembling beneficiaries from communities of coloration, dwelling in rural areas, or dually eligible for Medicare and Medicaid. Notably, comparatively few research particularly look at these inhabitants subgroups, so it’s tough to evaluate the energy of the findings or how broadly they apply. For instance, one research discovered that Black Medicare beneficiaries had larger charges of doubtless avoidable hospitalizations in Medicare Benefit than in conventional Medicare. Whereas vital, we couldn’t determine extra analyses that in contrast the speed of doubtless avoidable hospitalizations between Medicare Benefit and conventional Medicare amongst Hispanic and different beneficiaries of coloration, beneficiaries dwelling in rural areas, or beneficiaries dually eligible for Medicare and Medicaid. Moreover, regardless of an elevated concentrate on various fee fashions in Medicare, we solely recognized two research that differentiated conventional Medicare beneficiaries attributed to accountable care organizations (ACOs) from conventional Medicare beneficiaries not attributed to ACOs.

Our findings throughout all measures are summarized under.

Beneficiary Expertise

Satisfaction, entry to care, care coordination, and expertise with prescribed drugs: Beneficiaries in Medicare Benefit and conventional Medicare reported related charges of satisfaction with their care, and related experiences with wait occasions, discovering a brand new supplier, and general measures of care coordination. Nonetheless, Medicare Benefit enrollees had been extra more likely to report having a normal supply of care, receiving data throughout care transitions, and having higher experiences getting wanted prescribed drugs.

Switching: General, there have been low charges of switching between Medicare Benefit and conventional Medicare, although a barely bigger share of Medicare Benefit enrollees opted to change from Medicare Benefit to conventional Medicare than beneficiaries who switched from conventional Medicare to Medicare Benefit. Moreover, charges of switching from Medicare Benefit to conventional Medicare had been comparatively larger amongst beneficiaries who’re dually eligible for Medicare and Medicaid, beneficiaries of coloration, beneficiaries in rural areas, and following the onset of a practical impairment. Switching charges could also be a proxy for dissatisfaction with present protection preparations.

Affordability

A considerably smaller share of beneficiaries in conventional Medicare with supplemental protection than Medicare Benefit enrollees reported having cost-related issues. Comparable findings had been noticed amongst Black beneficiaries, beneficiaries beneath the age of 65, and beneficiaries in honest or poor self-assessed well being. Beneficiaries in conventional Medicare with no supplemental protection had larger charges of cost-related issues than beneficiaries enrolled in Medicare Benefit plans. Three research analyzing beneficiaries with high-needs, diabetes, or a psychological sickness discovered no variations in affordability-related measures between Medicare Benefit and conventional Medicare.

Utilization

Preventive providers: Medicare Benefit enrollees had been extra probably than beneficiaries in conventional Medicare to obtain preventive care providers, resembling annual wellness visits and routine checkups, screenings, and flu or pneumococcal vaccines, based mostly on a number of research, with related findings for folks of coloration and beneficiaries beneath age 65.

Hospital Companies: Variations in using hospital providers between folks in Medicare Benefit and conventional Medicare diverse based mostly on how hospital utilization is measured. General, there have been usually no variations within the combination variety of hospital days or common size of keep for frequent medical admissions, based mostly on proof from 5 research. 4 research discovered fewer hospital stays amongst Medicare Benefit enrollees in comparison with conventional Medicare beneficiaries for a minimum of some teams of beneficiaries. Variations within the share of beneficiaries with a minimum of one hospital keep diverse, with two research discovering no variations between Medicare Benefit and conventional Medicare and two research discovering decrease charges in Medicare Benefit. No research examined variations in hospital utilization between Medicare Benefit and conventional Medicare by race and ethnicity or different demographics.

Publish-Acute Care: A number of research reported decrease charges of expert nursing facility (SNF), inpatient rehabilitation facility (IRF), and residential well being use amongst Medicare Benefit enrollees, and shorter lengths of keep in SNFs and IRFs for Medicare Benefit enrollees than conventional Medicare beneficiaries. Throughout the seven research that examined the connection between post-acute care use, house well being use, and affected person outcomes, research usually discovered decrease hospital readmission charges amongst Medicare benefit customers of SNFs and decrease hospitalization charges amongst Medicare Benefit customers of house well being, however blended outcomes throughout different outcomes of care. None of those research offered outcomes by race and ethnicity or different demographics.

Prescription Medicine: Findings on prescription drug use diverse relying on the measure of utilization and situation studied. Three research discovered that amongst particular teams – folks with a psychological sickness, diabetes, Alzheimer’s illness, and high-need beneficiaries (every studied individually) – there have been no variations in using prescribed drugs between Medicare Benefit and conventional Medicare beneficiaries. Two of those research discovered that using prescribed drugs was larger for Medicare Benefit enrollees than conventional Medicare beneficiaries with out diabetes and with out Alzheimer’s illness. Conversely, one other research discovered that Medicare Benefit enrollees had been much less probably than conventional Medicare beneficiaries in stand-alone prescription drug plans to fill a minimum of one prescription for an opioid. None of those research stratified outcomes by race and ethnicity or different demographic teams.

Doctor-administered medicine (i.e., Half B medicine): A single research examined using physician-administered medicine and located no distinction between Medicare Benefit enrollees and conventional Medicare beneficiaries within the variety of injectable drug procedures. One other research discovered that Medicare Benefit enrollees had been extra probably than conventional Medicare beneficiaries to obtain low-cost Half B medicine in 4 scientific eventualities the place related or equally efficient medicine exist, suggesting that Medicare Benefit protection could also be related to extra environment friendly prescribing of Half B medicine. These two research didn’t current outcomes by race, ethnicity, or different demographics.

Different medical supplier and emergency division visits: Medicare Benefit enrollees had fewer medical supplier visits general, however extra major care visits per particular person, based mostly on 4 of the six research we reviewed that in contrast the variety of supplier visits between beneficiaries enrolled in Medicare Benefit and conventional Medicare. Emergency division (ED) use was usually related amongst Medicare Benefit and conventional Medicare beneficiaries general, based mostly on one research. A second research that targeted on beneficiaries in a single hospital-based supply system (Banner Well being) discovered that Medicare Benefit enrollees had larger ED go to charges than conventional Medicare attributed to an ACO and conventional Medicare beneficiaries not attributed to an ACO. None of those research offered outcomes by race, ethnicity, or different demographics.

High quality

Hospital Readmissions: Seven of the 12 research evaluating hospital readmission charges discovered decrease general readmission charges amongst Medicare Benefit enrollees than amongst conventional Medicare beneficiaries. Nonetheless, 4 research that had been restricted to beneficiaries in a single hospital or beneficiaries present process particular procedures, resembling knee/hip replacements, discovered no variations. One research that checked out readmission charges for folks with three persistent situations (myocardial infarction, congestive coronary heart failure, and pneumonia) discovered larger readmission charges amongst Medicare Benefit enrollees relative to beneficiaries in conventional Medicare. In two separate research, Black beneficiaries had larger readmission charges than White beneficiaries in each Medicare Benefit and conventional Medicare.

Doubtlessly avoidable hospitalizations: One research discovered that Black beneficiaries had larger charges of doubtless avoidable hospitalizations for ambulatory care delicate situations (ACSCs) in Medicare Benefit than in conventional Medicare. One other research examined charges of hospitalization for ambulatory care delicate situations general and by scientific situation, discovering that conventional Medicare beneficiaries had been hospitalized extra usually than Medicare Benefit enrollees for ACSCs; nevertheless, this research didn’t account for variations within the traits of Medicare Benefit enrollees and conventional Medicare beneficiaries.

High quality of facility or supplier: 5 of six research we reviewed that checked out high quality rankings of well being care amenities and suppliers utilized by Medicare Benefit enrollees and conventional Medicare beneficiaries discovered that Medicare Benefit enrollees had been much less probably than conventional Medicare beneficiaries to obtain care within the highest-or lowest-rated hospitals general or within the highest-rated hospitals for most cancers care, expert nursing amenities (SNFs), and residential well being companies. A sixth research examined 18 facility-level high quality measures in long-stay nursing houses (i.e., nursing houses) and short-stay nursing houses (i.e., SNFs), discovering no variations between Medicare Benefit and conventional Medicare for ten of the measures. Nonetheless, the remaining eight measures had blended findings, with Medicare Benefit enrollees having decrease threat of antipsychotic drug use whereas conventional Medicare beneficiaries having decrease threat of reasonable to extreme ache and urinary incontinence.

Illness administration (coronary heart illness and diabetes): Findings on illness administration diverse by situation and high quality measure. Amongst beneficiaries with coronary heart illness, Medicare Benefit enrollees had been extra probably than these in conventional Medicare to obtain guideline-recommended therapies in ambulatory settings, however there have been no variations reported in inpatient settings. Moreover, amongst folks with diabetes, Medicare Benefit enrollees had been extra probably than beneficiaries in conventional Medicare to be prescribed guideline-recommended remedy, use remedy for his or her situation, and carry out higher on scientific care measures resembling diabetic eye examination screening; nevertheless, there have been no variations in blood sugar management, insulin use, or receipt of blood diabetes exams between Medicare Benefit enrollees and conventional Medicare beneficiaries.

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