Medicare Advantage (MA) is enrolling more low-income and medically complex beneficiaries, according to a new analysis from the Commonwealth Fund.
MA has grown significantly over the past 20 years, with one of three Medicare beneficiaries now covered by the private plans. However, little is known about their characteristics or experiences. So the Commonwealth Fund, a private U.S. foundation that supports independent research on health care issues, recently conducted a study to analyze MA enrollees’ demographic, socioeconomic, and clinical characteristics as well as spending and quality of care.
The study is the first comprehensive analysis of changes in the MA population between 2012 and 2015.
To gain a better picture of MA members, the organization conducted retrospective observational cohort analyses of Medicare encounter data for more than 2 million MA beneficiaries in 2012 and 1.8 million in 2015.
According to the issue brief:
- Between 2012 and 2015, the MA population grew younger and included greater proportions of racial and ethnic minorities. There were also more low-income beneficiaries, more living in poor neighborhoods, and more living in neighborhoods where few residents have college degrees.
- While chronic conditions had not become more prevalent by 2015, a greater proportion of beneficiaries had complex medical needs.
- Hospitalization rates were stable, but lengths of hospital stays increased as did use of observation stays and emergency department visits.
- Spending was 13 percent higher in 2015, largely because of spending on prescription drugs.
- Performance on several measures of health care quality improved, but medication adherence declined slightly.
As a result of the findings, researchers said MA plans will need to develop targeted interventions to address beneficiaries’ social risks, avoid medical complications, and increase medication adherence. Plans also need to reduce spending on post acute care, for example, by expanding use of services provided in beneficiaries’ homes. Click here to read the full report.