Medicare Advantage And Traditional Medicare Differences: The Authors Reply

Letters Health AffairsVol. 42, No. 10: Tackling Structural Racism In Health Medicare Advantage And Traditional Medicare Differences: The Authors ReplyBruce E. Landon, Vilsa Curto, and John Z. Ayanian Affiliations Bruce E. Landon([email protected]), Harvard University and Beth Israel Deaconess Medical Center, Boston, Massachusetts. Vilsa Curto, Harvard University, Boston, Massachusetts. John Z. Ayanian, University of Michigan, Ann Arbor, Michigan.PUBLISHED:October 2023Open Accesshttps://doi.org/10.1377/hlthaff.2023.00992AboutSectionsView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsDownload Exhibits TOPICSMedicare AdvantageTraditional MedicareWe agree with James G. Kahn that available quality measures fail to capture many valuable aspects of care, including diagnostic and technical skills, and that some measures are gameable. For this reason, we also assessed a variety of patient-reported measures related to access to and experiences with care that are not gameable, and our analyses of these measures showed consistent findings (April 2023).We also agree that Medicare Advantage (MA) plans have strong incentives to select enrollees conditional on risk score, but the extent to which plans are able to do so is a matter of debate. Instead, MA health plans have become adept at coding intensively, which has resulted in substantial overpayments.1,2 This problem is why we used a risk-adjustment approach based on medication use that did not rely on coded diagnoses. Although this approach is incomplete, as evidenced by the higher three-year mortality rates in traditional Medicare, conditional on risk score, the correction factors we applied resulted in similar mortality among the groups at three years (see the appendix in our original article). Moreover, our findings related to hospitalizations are consistent with the even larger decrease in emergency department visits that we observed.As noted by Kahn, the current structure of MA is problematic, with overpayments resulting in excessive profits for MA health plans. Nonetheless, MA profits are surging as beneficiaries continue to flock to MA plans, perhaps because of the plans’ more generous benefits.3 At a time when US health care spending is approaching 20 percent of gross domestic product, our analyses provide evidence on the potential of Medicare managed care to control health care spending while also preserving quality, but program change will be required if the government is to share in these savings.NOTES1 Geruso M , Layton T . Upcoding: evidence from Medicare on squishy risk adjustment. J Polit Econ. 2020;12(3):984– 1026. Crossref, Medline, Google Scholar 2 Keating NL . Challenges and opportunities to address aggressive coding practices by Medicare Advantage plans. Ann Intern Med. 2023;176(7):987– 8. Crossref, Medline, Google Scholar 3 Meyers DJ , Trivedi AN . Trends in the source of new enrollees to Medicare Advantage from 2012 to 2019. JAMA Health Forum. 2022;3(8):e222585. Crossref, Medline, Google Scholar Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article Metrics History Published online 2 October 2023 Information© 2023 Project HOPE—The People-to-People Health Foundation, Inc.PDF downloadRelated articlesMedicare Advantage And Traditional Medicare Differences02 Oct 2023Health Affairs