By Blair Ford Mohney and Sarah Grace
In the last post, we highlighted trends in the migration of beneficiaries between Medicare fee-for-service and Medicare Advantage in the United States. In doing so, we can understand why this is such a hot topic for so many of our members across various markets. We are regularly asked: What can we learn about Medicare Advantage populations based on the fee-for-service data? How can we use it to reach more patients and improve their health outcomes?
At CareJourney, we pride ourselves on making data actionable. Medicare Advantage “switchers” data is no anomaly. As described in part one of this series, the actionable opportunities we see for this data include improving plan selection and patient care. Yet, as the industry is well aware, Medicare Advantage data is rare, inconsistent, and not standardized. This presents a challenge for data access and interpretation. So, what is an organization to do?
CareJourney’s main source of data is fee-for-service (FFS) Medicare claims. We believe that these are a good proxy to understand Medicare Advantage populations and the care they receive. Some people may question whether this data is a relevant apples-to-apples comparison. By focusing on the population of beneficiaries switching from fee-for-service to Medicare Advantage who have been in both populations, we can begin to answer this question.
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Who exactly are Medicare Advantage “switchers”?
While the answer is complex and situationally dependant, we can look at this question from three different vantage points.
As a reminder, this analysis is based on paired year-over-year enrollment data between 2013-2018. In the “base” year, beneficiaries are classified based on a full year of enrollment in either traditional 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”.
Do beneficiaries switch to Medicare Advantage at higher rates when they are first eligible?
It is reasonable to wonder if the “switchers” population predominantly consists of individuals newly eligible for Medicare. If this were the case, it would imply that this is an inherently different population than the individuals in the historical fee-for-service claims.
The data suggests that this is not the case. Among brand new Medicare-eligible patients, about 28% enrolled straight into a Medicare Advantage plan. Looking further, about another 4% switched into Medicare Advantage from fee-for-service after one year of Medicare eligibility. In total, this yields about a 32% Medicare Advantage penetration rate among these newly eligible beneficiaries. In comparing this to the overall percentage of Medicare patients who are enrolled in a Medicare Advantage plan (not solely those newly eligible), we see comparable proportions.
Additionally, while this 32% of newly eligible Medicare patients enrolling straight into a Medicare Advantage plan might seem high, these newly eligible “switchers” only represent about 1% of all beneficiaries switching into Medicare Advantage in any given year.
The main takeaway here is that patients are switching into Medicare Advantage across all points of their Medicare journey and not just when they are new to Medicare (as noted below, the average age of “switchers” is about 71). As a result, a lot of the patients were enrolled in fee-for-service at one point in time and we have historical claims outlining their patient history.
Are Medicare Advantage “switchers” different in age and risk from fee-for-service “stayers”?
In the chart below, we are able to see the average age and the Hierarchical Condition Category (HCC) risk scores for patients. These patients are broken down into two cohorts:
- Stay – those who are enrolled in fee-for-service (FFS) in the base year, and remain in FFS in the subsequent year (the year noted)
- Switch – those who are enrolled in FFS in the base year, and switch into a Medicare Advantage plan in the subsequent year (the year noted)