By Sarah Grace and Blair Ford Mohney
Data Visualization by Cody Elias
CareJourney’s Network Advantage platform is largely built upon the full Medicare fee-for-service claims dataset, but it is used by members to draw insights about population health and quality of care for all Medicare enrollees. While fee-for-service and Medicare Advantage beneficiaries are sometimes considered as two distinct groups, these populations are fluid, as beneficiaries can switch enrollments in any given year. Focusing on this population of “switchers” has distinct benefits for payers and providers alike.
Over a series of two blog posts, we leverage longitudinal beneficiary-level enrollment data from 2013-2018 to look at the migration of patients between traditional fee-for-service Medicare and Medicare Advantage plans. By honing in on this population, we can begin to answer the following questions:
- Where are “switchers”? What can we learn from observing geographic enrollment trends over time?
- Who are “switchers”? Are they different from overall fee-for-service populations?
There are two particular advantages of focusing on the population of beneficiaries switching between traditional fee-for-service and Medicare Advantage.
- Plan Selection – By understanding what types of beneficiaries are switching into Medicare Advantage, health plans can effectively match populations with specific healthcare needs to the plans that best address those needs.
- Patient Care – By understanding common gaps in chronic condition coding between individual patients enrolled in fee-for-service one year, and Medicare Advantage the next year, providers can identify opportunities to more accurately capture the risk of their fee-for-service populations.
Coming out of the Blue Button Developer conference, there is particular interest in this “switcher” population; if these patients opt in to data sharing via Blue Button, there is significant opportunity to gain access to more complete data, more quickly, to “enable better care coordination, better patient outcomes and reduced costs” (as discussed in the CMS Interoperability and Patient Access Proposed Rule).
Where are “switchers”? What can we learn from observing geographic enrollment trends over time?
For this analysis, we observe paired year-over-year enrollment between 2013-2018. In the “base” year, beneficiaries are classified based on a full year of enrollment in either fee-for-service or Medicare Advantage. In the following year, beneficiaries are grouped based on whether they continued in their current enrollment for the full year, switched enrollments for the full year, or neither (beneficiaries who died or switched enrollment mid-year are in this group).
Leveraging demographic data for all enrollees, and claims data for fee-for-service enrollees, we can understand the differences in chronic condition prevalence and other personal characteristics between fee-for-service to Medicare Advantage “switchers” and fee-for-service “stayers”.
We also pair this enrollment data with plan identification data to identify where switchers into Medicare Advantage enrolled, and whether significant trends exist for enrollees switching between Medicare Advantage plans.
Build and Optimize Networks of Care with Network AdvantageREQUEST A DEMO
Use the dashboard below to view Medicare Advantage penetration rates, fee-for-service to Medicare Advantage switch rates, and Medicare Advantage to fee-for-service switch rates over the past few years. In the first part of the dashboard, view national or state-level trends. In the second part of the dashboard, view trends for individual core-based statistical areas (CBSAs) of interest.
Note that national rates on the state-level charts in the dashboard below are raw state-level averages. Actual national rates can be viewed by selecting “National” on the CBSA-level charts.