Quality in Medicare FFS and Medicare Advantage

Medicare Advantage had another year of solid enrollment growth and over a third of Medicare beneficiaries are enrolled in MA plans; a number that may grow to 50% in a few years.  As the program grows, understanding its effects on Medicare costs and beneficiary health are important.  A recent study in Health Services Research examined relative quality in Florida, New York and California, which account for a significant percentage of MA enrollees.   (HSR Article)   One benefit MA plans clearly have for their members is a richer set of benefits, typically with lower cost-sharing than the fee-for-service version of Medicare.  Prior research generally demonstrated that MA had better performance on certain types of quality measures, while FFS Medicare generally had higher patient satisfaction scores.  This likely reflects the trade-off that beneficiaries perceive of less choice in MA, but lower costs and better quality.  The researchers used data from 2012, which seems old, but maybe is the latest they could get, and did a variety of analyses.  They looked at 10 HEDIS measures, 6 other quality measures used in Stars ratings, 6 measures of patient experience of care, five measures relating to prescription drugs and whether or not the flu vaccine was given.  The authors also attempted to understand the extent to which case-mix adjustments and various demographics and social factors might affect the results.

The results are pretty clear and dramatic.  Medicare Advantage outperformed FFS Medicare on every one of the 16 clinical quality measures, by amounts ranging from 2.3 percentage points to 42.  Medicare Advantage also outperformed on the drug measures, but by smaller amounts.  Patient experience of care was somewhat mixed, with MA better on four, FFS on one, and one, care coordination, had no difference.  After case mix adjustment, FFS results improved somewhat but were still not as good as MA performance.  HMO model MA plans had better results than did PPO models and in some cases, PPO model plans were not as good as FFS Medicare.  At a contract level of analysis, there were a few MA plans that had very good results that may skew the favorability of MA outcomes.  The general message, which I think later data will demonstrate even more clearly, is that MA plans will deliver good quality for beneficiaries, even if there is some perception of more limited provider choice, but beneficiaries should examine quality outcomes carefully among plans and should think about what model of plan they enroll in.  PPO models that look like FFS also don’t deliver much better quality than FFS.