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Favorable Risk Selection in Medicare Advantage: Trends in Mortality and Plan Exits Among Nursing Home Beneficiaries.

TitleFavorable Risk Selection in Medicare Advantage: Trends in Mortality and Plan Exits Among Nursing Home Beneficiaries.
Publication TypeJournal Article
Year of Publication2017
AuthorsGoldberg EM, Trivedi AN, Mor V, Jung H-Y, Rahman M
JournalMed Care Res Rev
Volume74
Issue6
Pagination736-749
Date Published2017 12
ISSN1552-6801
KeywordsAged, Aged, 80 and over, Female, Forecasting, Health Expenditures, Humans, Male, Medicare Part C, Mortality, Nursing Homes, Risk Adjustment, United States
Abstract

The 2003 Medicare Modernization Act (MMA) increased payments to Medicare Advantage plans and instituted a new risk-adjustment payment model to reduce plans' incentives to enroll healthier Medicare beneficiaries and avoid those with higher costs. Whether the MMA reduced risk selection remains debatable. This study uses mortality differences, nursing home utilization, and switch rates to assess whether the MMA successfully decreased risk selection from 2000 to 2012. We found no decrease in the mortality difference or adjusted difference in nursing home use between plan beneficiaries pre- and post the MMA. Among beneficiaries with nursing home use, disenrollment from Medicare Advantage plans declined from 20% to 12%, but it remained 6 times higher than the switch rate from traditional Medicare to Medicare Advantage. These findings suggest that the MMA was not associated with reductions in favorable risk selection, as measured by mortality, nursing home use, and switch rates.

DOI10.1177/1077558716662565
Alternate JournalMed Care Res Rev
PubMed ID27516452
PubMed Central IDPMC5303571
Grant ListT32 AG023482 / AG / NIA NIH HHS / United States
R01 AG044374 / AG / NIA NIH HHS / United States
R01 AG047180 / AG / NIA NIH HHS / United States
P01 AG027296 / AG / NIA NIH HHS / United States
T32 HS000011 / HS / AHRQ HHS / United States
Category: 
Faculty Publication