Unbiased Analysis of Today's Healthcare Issues
Medicare’s cost are growing due to an aging population, technological advances, and other factors. One of those factors may be upcoding that is occurring among Medicare Advantage plans. Rick Kronick writes in Health Affairs that: Over the past decade, the average risk score for Medicare Advantage (MA) enrollees has risen steadily relative to that for fee-for-service…
CMS announced last week that they are extending their value-based insurance design (VBID) program to more states and more patients. I describe VBID and the proposed changes below. What is VBID? Value-Based Insurance Design (VBID) generally refers to health insurers’ efforts to structure enrollee cost sharing and other health plan design elements to encourage enrollees…
Do patients who enroll in Medicare Advantage go to the hospital less frequently? The answer is yes. However, this fact may not be causal. Patients who enroll in Medicare Advantage are generally younger and healthier than patients who enroll in Medicare’s fee-for-service (FFS) program. A paper by Duggan, Gruber and Vabson (2016) uses a novel…
In the 1990s, managed care began to take over the health care marketplace. However, backlash against managed care lead to a retrenchment in managed care in the late 1990s. A paper by Sinaiko and Zeckhauser (2015) notes that: After the MA-plan payment cuts imposed through the Balanced Budget Act of 1997, HMO availability dropped by nearly…
Although the typical economist answer would be yes, in the case of one Medicare Advantage program, the answer is ‘no’. A paper by Layton and Ryan (2015) [earlier draft] examine the Medicare Advantage Quality Bonus Payment Demonstration (MA QBP) which began in 2012. In this program: …plans receive bonus payments based on an overall plan quality…
About two-thirds of Medicare beneficiaires are enrolled in tradiational Medicare FFS, but the remaining thrid is now enrollingin Medicare Advantage plans. Which plans are dominant? The following figure from Avalere provides a breakdown. Note that this figure obscures significant regional variation in plan market share. For instance, Kaiser Permanente has almost half (48%) of the…
Austin Frakt summarizes some recent research presented at AcademyHealth. There are three principle MA plan types: HMOs, PPOs, and private fee for service (PFFS) plans. It’s HMOs that are lowest in cost, because they tend to offer the most restrictive networks. As Biles et al. report, based on 2012 data, HMOs have costs 7 percent…
A KFF article provides some highlights of changes to Medicare Advantage for 2015: Near universal access to an MA plan. 99% of Medicare beneficiaries will have access to a Medicare Advantage plan as an alternative to traditional Medicare in 2015. The only individuals without access to an MA plan are concentrated in a few rural areas. Lots of…
Austin Frakt says although Medicare Advantage plans used to be considered high cost, low-quality options, in recent years, these Medicare Advantage plans have vastly increased quality of care and have become less focused on cream-skimming healthier patients. Medicare Advantage plans — private plans that serve as alternatives to the traditional, public program for those…
In 1995, Newt Gingrich claimed that Medicare would end. He stated that “going to wither on the vine because we think people are voluntarily going to leave it — voluntarily.” Was he right? In the one hand, Medicare total enrollment and spending is rising and the program still has widespread political support. On the other…