RISE summarizes the latest research news involving Medicare Advantage (MA) and Medicaid.
Study: MA members have better patient experiences with primary care than those in original Medicare
Medicare Advantage (MA) beneficiaries have higher engagement with primary care and better patient experiences compared to fee-for-service (FFS) Medicare, according to recent research conducted by ATI Advisory on behalf of the Better Medicare Alliance, a leading research and advocacy organization supporting MA.
The brief is based on interviews with two MA organizations and three primary care provider organizations, an analysis of the 2020 Medicare Current Beneficiary Survey, and a policy review.
The study finds four strategies that MA organizations leverage to improve the quality of primary care and enrollee engagement:
Access and enrollee engagement: MA organizations encourage enrollees to engage in primary care, and both MA and primary care provider organizations work together to support timely access to care.
Partnerships and value-based care: MA organizations offer a diverse array of value-based partnerships to incentivize quality care among primary care provider organizations.
Data and data sharing: MA and primary care provider organizations participate in data exchange to meet care gaps, share risk stratification strategies, reduce administrative burdens, and enable value-based relationships.
Communication and care management: MA and primary care provider organizations often collaborate through open communication to ensure enrollees receive the care they need and appropriately allocate care management responsibilities.
“Primary care is essential to helping Medicare Advantage beneficiaries navigate their health, prevent disease, and manage chronic illnesses to improve their quality of life,” said Mary Beth Donahue, president and CEO of the Better Medicare Alliance, in an announcement. “This research demonstrates how the flexibility of Medicare Advantage leads to innovation and collaboration with primary care providers that better serves the millions of seniors and people with disabilities who choose Medicare Advantage.”
AHIP research shows higher quality of care in MA compared to original Medicare
A study released by AHIP has found that MA enrollees receive higher quality care than those in original Medicare.
The study compared performance results for Healthcare Effectiveness Data and Information (HEDIS ®) measures focused on preventive and chronic disease care in original Medicare and MA in 2019. After examining data from 11 HEDIS measures, the study found that MA outperformed original Medicare in all but one. The analysis found that a higher share of MA enrollees were screened for two common forms of cancer than their original Medicare counterparts.
Jeanette Thornton, AHIP executive vice president of policy & strategy, said in an announcement that the study highlights that MA provides high-quality care, with lower costs, more choices, and better outcomes for the American people. “Preventive care is essential to promote long-term wellness, reduce incidence of disease, and save money for consumers,” she said.
Despite declining use, Medicaid spending on prescription drugs has increased; and more
Despite a lower number of prescriptions in recent years, Medicaid spending on prescription drugs has increased, according to a recent KFF analysis. Medicaid outpatient prescriptions peaked in 2017, before starting to decline and remaining below 2017 levels through 2022–even with historic levels of Medicaid enrollment growth.
Both gross and net (after rebates) spending on prescription drugs have increased every year since 2019, likely driven by high-cost brand drugs, KFF said in the study announcement. Net spending on Medicaid prescription drugs increased by 47 percent between 2017 and 2022 (from $29.8 billion to $43.8 billion) and net spending per prescription increased from $39 to $58 between 2017 and 2022. Growth in prescription drug rebates was slower than gross spending growth between 2017 and 2022.
Studies have found substantial drug price increases beyond the rate of inflation in recent years as well as increasing launch prices for new drugs.
As a result, various federal actions have sought to address high prescription drug costs. This includes new threats from the Biden administration to license certain patents for costly drugs developed with government research funding to other drug makers, and the passage of the Inflation Reduction Act. In Medicaid, cost containment efforts have also recently emerged in proposed legislation to regulate pharmacy benefit managers, including the House’s newly passed Lower Costs, More Transparency Act, and a new proposed federal rule with provisions that increase price transparency.
Over two-thirds of states also reported new or expanded initiatives to contain prescription drug costs in KFF’s annual survey of state Medicaid programs.
Even if national utilization trends remain relatively stable, as they have in recent years as states unwind the continuous enrollment provision, loss of Medicaid coverage on an individual level could have severe consequences. In a recent KFF focus group report, Medicaid participants said that losing health insurance would be “devastating” due their need for “lifesaving” prescriptions and treatments.
Senior docs may care for fewer patients with Medicaid and racial/ethnic minorities than junior physicians
Senior physicians may avoid seeing racial minorities and lower paying Medicaid-insured patients compared to junior physicians in the same practice, according to a study led by Harvard T.H. Chan School of Public Health and published in JAMA Network Open
“It’s a widely known ‘secret’ that in some practices, the older doctors push patients with lower-paying insurance, and by extension patients of minority races to the more junior doctors in their clinic. But this is rarely discussed openly,” said lead author Michael Barnett, associate professor of health policy and management, in a study announcement. “Our study finds evidence to back up this hidden practice, which raises concerns of a two-tiered system by physician seniority that promotes racial and economic segregation.”
Researchers used 2017 claims data from athenahealth and 2021 claims data from Medicare—representing over 134 million patients and nearly 200,000 physicians—to analyze the differences between patients seen by the most junior physicians versus patients seen by the most senior physicians. The researchers classified the physicians by practice type—cognitive (primary care or endocrinology, for example); procedural (any surgical or procedural specialty); or non-office-based (emergency medicine or radiology, for example)—and evaluated the patient panels within each group.
The study found gaps between the patient panels of junior and senior physicians in cognitive and procedural specialties, broken down by patient insurance type as well as race and ethnicity.
Within the athenahealth data:
- Senior cognitive physicians saw 1.6 percent fewer Medicaid patients and 1.2 percent fewer patients from racial/ethnic minorities compared to their junior counterparts
- Senior procedural physicians saw 2.9 percent fewer Medicaid patients and 1.7 percent fewer patients from racial/ethnic minorities.
The same trends were observed in the Medicare data, validating that these findings were not a result of one particular data source, researchers said, While the largest discrepancies were observed between procedural physicians, there were no significant discrepancies observed between non-office-based physicians, who do not see patients on scheduled visits.
The researchers said the lack of discrepancy in non-office-based physicians’ patient panels suggests that other specialties may exercise discretion in which patients are booked with whom. Cognitive and procedural specialists may be dissuaded by Medicaid’s lower reimbursement rates or higher administrative burden, and as such take on fewer of these patients. Since Medicaid patients are more likely to be racial and ethnic minorities, this could lead to racial disparities as well. The researchers noted that patient choice may also play a role in the gaps.
“It’s far from clear that senior physicians provide higher quality care than junior physicians,” Barnett said. “But in my experience as a primary care physician, many patients want to see a more experienced physician. Our study suggests that patients may encounter barriers on who they can see, even in the same practice, based on who they are and what insurance they can afford. Addressing these barriers and widening patient access to all kinds and levels of physicians is essential to a more equitable health care system.”