An article in the New England Journal of Medicine reports on a study in which the authors compared enrollment in Medicare Advantage plans which offered fitness club memberships with those plans which did not include such an offering, with the objective of ascertaining whether the plans thereby cherrypicked healthy beneficiaries for enrollment. (NEJM Article) The study was based on data from a self-reported Medicare survey and data from CMS about plan benefits. Eleven plans that offered fitness memberships were compared with 11 that didn’t. The eleven plans added the fitness membership benefit during the time period under study, so the self-reported profile of the enrollees before and after the benefit was added was compared, along with a comparison to the control plans. As might be expected, the proportion of healthy members after the fitness benefit was offered was higher. The authors’ main design screwup, which they fail to mention, and the data is easily available, is that they did not attempt to see if the plans were just adding more healthy enrollees, not losing less healthy ones. There is no evidence from this or other studies to suggest the unhealthy beneficiaries don’t enroll in plans which may have benefits attractive to healthy ones. The failure to do this analysis strongly suggests an agenda in the research.
It is hard not to suspect that these authors have an ideological biases which has led them to publish an ill-thought out piece which is clearly designed to trash Medicare Advantage plans. Contrary to the authors’ hypothesis, given how Medicare Advantage structures its reimbursement, plans can make more money by attracting sick members and managing their care much more effectively than it is managed in the fee-for-service part of Medicare. Almost every piece of credible research shows that Medicare Advantage plans provide higher quality care to their members than fee-for-service beneficiaries receive. The authors also seem to suggest that plans shouldn’t be allowed to offer these kinds of benefits to their members, which is simply ludicrous if we are interested in improving the health of Medicare beneficiaries. Instead of trying to keep healthy people out of Medicare Advantage or punish them in some way, maybe we should look for ways to get more of the ill population into them.