Study Finds Medicare Advantage Enrollees Have Lower Health Risks Based on Their Prescription Drug Use

Medicare beneficiaries enrolled in Medicare Advantage health plans appear to have lower overall risks for health problems, as measured by differences in the use of prescription medications, than people enrolled in traditional Medicare, according to a recent AHRQ study. The findings may indicate that Medicare Advantage plans attract healthier patients, authors suggested. The article, in Health Services Research, analyzed drug use patterns for Medicare beneficiaries to determine health risk. It found that beneficiaries enrolled in Medicare Advantage plans in 2015 had 6.9 percent lower health risk than beneficiaries in traditional Medicare. Access the abstract.

2018 May 22. doi: 10.1111/1475-6773.12977. [Epub ahead of print]

Getting What We Pay For: How Do Risk-Based Payments to Medicare Advantage Plans Compare with Alternative Measures of Beneficiary Health Risk?

Jacobs PD1, Kronick R2.

Author information

Abstract

OBJECTIVE:

To estimate the relative health risk of Medicare Advantage (MA) beneficiaries compared to those in Traditional Medicare (TM).

DATA SOURCES/STUDY SETTING:

Medicare claims and enrollment records for the sample of beneficiaries enrolled in Part D between 2008 and 2015.

STUDY DESIGN:

We assigned therapeutic classes to Medicare beneficiaries based on their prescription drug utilization. We then regressed nondrug health spending for TM beneficiaries in 2015 on demographic and therapeutic class identifiers for 2014 and used coefficients from this regression to predict relative risk of both MA and TM beneficiaries.

PRINCIPAL FINDINGS:

Based on prescription drug utilization data, beneficiaries enrolled in MA in 2015 had 6.9 percent lower health risk than beneficiaries in TM, but differences based on coded diagnoses suggested MA beneficiaries were 6.2 percent higher risk. The relative health risk based on drug usage of MA beneficiaries compared to those in TM increased by 3.4 p.p. from 2008 to 2015, while the relative risk using diagnoses increased 9.8 p.p.

CONCLUSIONS:

Our results add to a growing body of evidence suggesting MA receives favorable, or, at worst, neutral selection. If MA beneficiaries are no healthier and no sicker than similar beneficiaries in TM, then payments to MA plans exceed what is warranted based on their health status.