RISE summarizes recent research on Medicare Advantage.
Study explores MA design impact on health care utilization, health equity
A new white paper, the fourth in a series authored by Inovalon and Harvard Medical School, analyzes how Medicare Advantage (MA) plans’ finances and coverage design impact enrollment, socioeconomic-related health disparities, and utilization outcomes.
The findings show that zero-premium MA plans attract a more socioeconomically disadvantaged population compared to non-zero premium MA plans and traditional Medicare fee-for-service (FFS), and health maintenance organization plans have significantly lower utilization than preferred provider organization and FFS plans.
Specifically, the research found:
- Enrollees in zero-premium plans are three times as likely to be non-white and are more likely to live in urban areas than other MA and FFS enrollees
- Zero-premium MA enrollees have a net worth of 90 percent of the net worth of other MA enrollees and only 70 percent of FFS enrollees
- Compared to those in other MA or FFS plans, zero-premium enrollees are more likely to have a high school education or less, less likely to own their own home or vehicle, less likely to be married, and more likely to have difficulty speaking English
- MA HMO enrollees are three times more likely to be non-white than those in MA PPO plans
- Utilization under MA HMOs is 29 percent lower relative to a comparable population in MA PPOs, equating to $2,460 lower utilization per person annually
“Our analysis can help Medicare Advantage and other health plans more effectively serve their member populations by offering tailored designs and features,” said Christie Teigland, Ph.D., vice president of research science and advanced analytics at Inovalon and co-lead researcher on the project, in the study announcement. “With these insights health plans can project expected enrollment, evaluate the performance of their features against industry benchmarks, and identify opportunities to address health disparities and deliver optimal outcomes.”
J.D. Power report: Health plans don’t provide an adequate digital experience for consumers
Nearly one-third of health insurance websites and apps don’t meet the foundational level of functionality and intuitive organization of information, according to J.D. Power’s U.S. Healthcare Digital Experience Study SM, which evaluates customer interaction with their health plans via digital channels.
The report, conducted in collaboration with Corporate Insight, was based on evaluations from 5,590 members of the 14 largest MA plans and 15 largest commercial member plans in the United States. It examined the functional aspects of desktop, mobile web and mobile apps based on five factors: visual appeal; information/content; navigation; speed; and telehealth.
“Health care can learn from other industries in relation to leveraging digital to transform the customer experience,” said Christopher Lis, managing director of global healthcare intelligence at J.D. Power, in the study announcement. “World-class health care organizations are looking to banking, finance, retail and hospitality, among other industries, to gain insight into best practices to create excellence in omnichannel digital transformation. When health care is compared with other sectors, many lessons can be learned and integrated into the journey toward transformation."
Here are three key findings from the study:
Health insurance digital experience lags property and casualty (P&C) insurance: On average, the overall digital experience customer satisfaction score among commercial member health plans is 646 (on a 1,000-point scale) and 629 among MA plans. That compares with an average satisfaction score of 700 among P&C insurers; 718 among self-directed wealth management apps and websites; and 685 among retirement plans.
Nearly one-third of digital properties fail on basic functions: When it comes to the absolute basics of the digital experience (e.g., overall digital functionality, logical organization of information and visual appeal), 32 percent of the digital commercial member health plan and MA plan properties evaluated miss the mark. Just 21 percent of the digital properties evaluated satisfied all criteria for high-functioning digital solutions, such as clearly explaining coverage and usage; providing information on deductibles and out-of-pocket spend; and offering urgent telehealth services.
Digital experience linked to employer satisfaction and intent to renew: Among commercial member health plans that have overall satisfaction scores of 801 or higher, 53 percent of members are likely to have a much more positive impression of their employer. Among MA plans that have overall satisfaction scores of 801 or higher, 89 percent of members say they “definitely will” renew with their current plan.