The organizations recently released a study, the first white paper in a four-part series authored by researchers at Harvard Medical School and Inovalon that leverages Inovalon’s unique data assets and expertise.
Part one of a long-term research partnership between faculty in the Department of Health Care Policy at Harvard Medical School and Inovalon’s research science team initial findings reveal key differences between those who enroll in Medicare Advantage (MA) and those who enroll in traditional Medicare Fee-for-Service (FFS) regarding their health status, demographic, and socioeconomic characteristics.
The study is the first white paper in a four-part series authored by researchers at Harvard Medical School and Inovalon that leverages Inovalon’s unique data assets and expertise.
Research methods
The Inovalon research team constructed a sample of beneficiaries who turned 65 between 2015 and 2019, including 180,087 individuals who enrolled in FFS and 25,470 individuals who enrolled in MA. The study leveraged data from the one-year period prior to joining Medicare while enrollees were covered by commercial insurance, providing a clean line of sight into their diagnoses and characteristics prior to joining either MA or FFS. Previous research has compared beneficiaries after enrollment which introduces bias and potential contamination related to potential differences in coding and care provided. Beneficiaries were also linked to a granular source of data on social determinants of health (SDoH) to provide insights on differences in social risks faced by the two populations.
Key findings
The results offer a look into how MA and FFS enrollees differ and the populations that find MA more appealing than FFS. One finding previously not known was that MA enrollees were 50 percent more likely to have been enrolled in a commercial HMO plan prior to joining Medicare. This is important information for policymakers and health plans in understanding who is most likely to convert to MA vs FFS. Additionally, socially vulnerable populations, including racial/ ethnic minorities and those with lower income and education status, are more likely to enroll in MA than FFS. For instance, MA enrollees are twice as likely to be non-white and have a net worth that is 74.2 percent of the average traditional Medicare enrollee. 1
The choice for MA enrollees is likely related to several differences between the MA and FFS Medicare options. MA offers comprehensive benefits and care coordination while FFS has no active care management, so beneficiaries are on their own. This is naturally harder on socioeconomically disadvantaged populations who may need support such as transportation or help understand hospital discharge instructions. MA plans also offer additional benefits not available in FFS such as vision and dental care, transportation, and wellness programs.
Another important difference is that MA plans have substantially lower out-of-pocket costs and lower premiums than FFS. Different studies have come up with a range, but consistently show at least $1,000 lower out-of-pocket costs for those in MA than in FFS, all else equal. For individuals with worse health conditions, the difference may be even greater.
The study underscores the significant role that can MA play in promoting health equity, given the relatively socioeconomically disadvantaged population that it serves. Future white papers in this series will highlight how MA is achieving this goal and how Inovalon’s data can be used to support health plans in identifying and reducing health disparities.
Discover all the findings from this groundbreaking study
The results of the study provide a better understanding of the core customer segments of MA and which beneficiaries are more likely to enroll in MA vs. FFS. This research puts Inovalon in a unique position to support MA plans in delivering maximum value to members while optimizing marketing, growth, and retention efforts. Learn more about this research partnership and dive deeper into the insights.
1 “Harvard-Inovalon Medicare Study: Who Enrolls in Medicare Advantage vs. Medicare Fee-for-Service”, Scott Bilder, Zarek Brot-Goldberg, Barton Jones, Iman Mohammadi, Zulkarnain Pulungan, Yalun Su, Christie Teigland, and Boris Vabson, Inovalon, https://www.inovalon.com/resource/harvard-inovalon-medicare-study-who-enrolls-in-medicare-advantage-vs-medicare-fee-for-service/
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About the author
Christie Teigland, Ph.D., vice president, research science and advanced analytics, Inovalon, has been dedicated to improving the outcomes and economics of healthcare for over 25 years.
An economist and research statistician, she works with health plans, providers, and life science organizations to provide actionable, real-world data insights on performance measure development and testing, health disparities/equity, predictive analytics, comparative effectiveness, treatment patterns, and more. She serves as co-chair of the National Quality Forum (NQF) Scientific Methods Panel and is a member of the Pharmacy Quality Alliance (PQA) Quality Measure Expert Panel.