Old data hinders comparison of Medicare, Advantage plans

Authors call for better research to inform policy

A study comparing Medicare Advantage plans and traditional Medicare on healthcare access and quality found substantial limitations--mainly that much of the available research was old, according to a report published by the Henry J. Kaiser Family Foundation.

Researchers reviewed 45 studies published between 2000 and early 2014. It found, for example, that Medicare Advantage plans tend to score higher on performance indicators, particularly those for preventive care; patients tend to rate traditional Medicare higher on healthcare access and quality; and Medicare HMOs appear to provide a less resource-intensive style of practice than traditional Medicare.

However, the researchers noted difficulties in extracting a true comparison from their findings.

Among the problems:

  • Limited insight into the effects of the Affordable Care Act. None of the studies used data from 2010 or later.
  • Studies reflect mainly HMO experience, not newer plan types. In 2014, one-third of all Medicare Advantage enrollees are in other types of plans, primarily PPOs, but only three of the studies included findings specific to Medicare PPOs.
  • Limited insight into the experience of patients with complex medical needs.

"At a time when enrollment in Medicare Advantage is growing, it is disappointing that better information is not available to inform policymaking. Our findings highlight the gaps in available evidence and reinforce the potential value of strengthening available data and other support for tracking and monitoring performance across Medicare Advantage plans and traditional Medicare as each sector evolves," the authors wrote.

Nearly 54 million people are enrolled in Medicare plans, with 16 million of that total enrolled in Medicare Advantage plans.

Medicare plans have come under increased scrutiny after federal audits found the same deficiencies year after year. The Office of Inspector General's 2015 workplan turns an investigative eye on Medicare Advantage and manged-care plans sold under the Affordable Care Act.

"The OIG work plan serves as a blueprint for enforcement actions during the upcoming year and calls attention to medical initiatives officials believe are vulnerable to fraud and abuse," The Center for Public Integrity explained regarding the recent workplan, FierceHealthPayer previously reported.

To learn more:
- here's the KFF report

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