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Do recent changes in Medicare Advantage plan quality information help move beneficiaries from lower to higher-performing plans?

Tuesday, November 3, 2015

Amelia M. Haviland, PhD, Carnegie Mellon University, Pittsburgh, PA
Megan Mathews, RAND Corporation, Santa Monica, CA
Marc N. Elliott, PhD, RAND Corporation, Santa Monica, CA
Susan Paddock, PhD, RAND Corporation, Santa Monica, CA
Sarah Gaillot, PhD, Centers for Medicare & Medicaid Services (CMS), Baltimore, MD
Cheryl Damberg, RAND Corporation, Santa Monica, CA
Medicare Advantage (MA) is one of the few settings where extensive plan quality information and comparison tools are available to potential enrollees when making plan selections.  We investigate whether recent changes in Medicare rules that provide stronger ‘nudges’ to beneficiaries cause enrollment shifts to higher quality plans.

We used MA administrative data at the contract level including Star Ratings, enrollment, plan and enrollee characteristics, and premiums from 2008-2013. In 2012, 5-star plans were given extended marketing and special enrollment periods and received a special icon online. Starting in 2012, messaging warning beneficiaries away from enrolling in Low-Performing Icon (LPI) plans was put online, and in 2013, online enrollment was disabled, LPI enrollees received special dispensation to dis-enroll at any point in the year, and enrollees in LPI plans were sent a letter informing them of their plan’s LPI status and recommending they consider other plans. Fixed-effects linear regression models were used to assess enrollment changes in 5-star and LPI plans over time as quality information for these plans changed.

Of the 1625 plan-years for 2010-2013 Star Ratings, only 25 are 5-star and 105 are LPI plan-years. 5-star/LPI plans differ from all other plans by having considerably higher (for 5-star)/lower (for LPI) premiums, higher/lower proportion non-profit, and lower/higher proportions of dually eligible beneficiaries, versus all other plans. Relative to earlier years, 2013 LPI enrollment declined more during the year: a decline of an additional 4.5%, p < 0.01.  We do not detect enrollment changes for 5-star plans in later versus earlier years following the rule changes for these plans.  For changes during open enrollment, results are currently inconclusive on whether rule changes for LPI plans cause greater declines.  No open enrollment differences are detected for 5-star plans post rule changes. 

Rule changes strengthening incentives for beneficiaries to shift to higher quality MA plans were effective for moving enrollees out of the lowest performing plans but not necessarily into the highest performing plans. The ‘nudges’ for LPI plan enrollees were stronger and more targeted than those regarding 5-star plans. Other plans with similar premiums were available to LPI enrollees but switching to a 5-star plan, when available, typically involved paying a higher premium.

Learning Areas:

Communication and informatics
Conduct evaluation related to programs, research, and other areas of practice
Public health or related laws, regulations, standards, or guidelines
Public health or related organizational policy, standards, or other guidelines
Public health or related public policy

Learning Objectives:
Evaluate recent changes in Medicare plan quality rules and whether they succeed in moving Medicare Advantage beneficiaries out of low-performing and into high-performing plans. Determine features of quality information and choice settings, i.e., nudges, that are effective in moving Medicare beneficiaries into higher quality plans.

Keyword(s): Decision-Making, Quality of Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the principal /co-principal investigator of several federally- or foundation-funded grants/contracts regarding health services research. I have published more than 50 articles in peer-reviewed publications in this area with more than 1,200 citations. My scientific research interests include health insurance design, Medicare policy, vulnerable populations and health disparities, consumer evaluation of healthcare, statistical analyses, and survey methodology.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.