With MA Growing, Time to Make Some Comparisons

Enrollment in Medicare Advantage has been increasing steadily since the early 2000. Now more than a third of Medicare beneficiaries are enrolled in Medicare Advantage plans of one kind or another. researchers and policymakers are increasingly interested in making comparison between beneficiaries in Medicare Advantage plans to beneficiaries who are in traditional, fee-for-service.

But there is a problem, says Amol Navathe, M.D., Ph.D., an assistant professor in the Departmentof Medical Ethicsand Health Policy at University of Pennsylvania’s Perelman School of Medicine.

“In general, we tend to know less about Medicare Advantage performance, quality and outcomes than we do about Medicare fee for service because as private plans access to their data is therefore constrained,” Navathe said in a recent video interview with Managed Healthcare Executive®. “Access to the Medicare fee for service program is open so a lot of researchers like myself are able to access that data and study it quite carefully. UnderstandingMA versus fee for service is challenging.”

But Navathe and his colleagues took on that challenge recently after getting access to data for Medicare beneficiaries with end-stage renal disease who were enrolled in a CareMore Medicare Advantage Special Needs Plan. The study was supported by a grant from the Anthem Public Policy Institute, and CareMore is a subsidiary of Anthem. The co-authors include Sachin H. Jain, the former president and CEO of CareMore, and Jennifer Kowalski, vice president of the Anthem Public Policy Institute. They reported their results in this month’s issue of Health Affairs.

People with end-stage renal disease have eligible for Medicare, regardless of their age, since the early 1970s. About 750,000 Americans have end-stage renal disease

Navathe said extending Medicare coverage to patients with end-stage renal stage makes sense because the need for dialysis results in “functional disability.”

“End-stage renal disease is almost synonymous with requiring dialysis. And dialysis typically — at least traditional dialysis that is called hemodialysis that is most prevalent —requires patients to be dialyzed four to six hours a day, three days a week, and effectively renders them very difficult to employ.”

Navathe explained that Special Needs Plans are a subset of Medicare Advantage plans for beneficiaries with chronic or disabling conditions like end-stage renal disease. There are also Special Needs Plans for beneficiaries who are dually eligible for Medicare and Medicaid. According to the Kaiser Family Foundation, enrollment in Special Needs Plans increased from 2.6 million beneficiaries in 2018 to 2.9 million beneficiaries last year, and enrollees in the plans accounted for about 13 percent of the total Medicare Advantage enrollment in 2019. Roughly 350,000 of the 2.9 million Special Needs Plans members are people with chronic or disabling conditions such as end-stage renal disease, according to the foundation’s figures.

Navathe noted that the care of people with conditions like end-stage renal disease should be researched because they of their vulnerability, medical needs — and the expense.

“As policymakers, as taxpayers, as stakeholders in the industry, we should take note of a very expensive, vulnerable population and how they are doing in different in different types of programs that are being offered, especially when we have very little information to date.”