Health Plan Participation in the Medicare Managed Care Market

Medicare;health insurance;health care financing;not listed

Adrion, Emily RichardsRiley, Anne ;

Johns Hopkins University

关键词: Medicare;    health insurance;    health care financing;    not listed;   

Others  :  https://jscholarship.library.jhu.edu/bitstream/handle/1774.2/60564/ADRION-DISSERTATION-2015.pdf?sequence=1&isAllowed=n

瑞士|英语

来源: JOHNS HOPKINS DSpace Repository

【 摘 要 】

BACKGROUND: The payment and regulatory policies facing Medicare managed care plans have changed considerably over time, but rather than being evidence-based, these policy changes have often been politically motivated. Shifts in Medicare managed care policies have seemingly been accompanied by fluctuations in plan participation. PURPOSE: The purpose of this research is to identify and understand the factors associated with plan participation in the Medicare managed care market.DATA AND METHODS: This study utilizes data from the Centers for Medicare and Medicaid Services, the HealthLeaders-InterStudy Managed Market Surveyor-Rx data files, the Area Health Resources File, the Census, and the Current Population Survey. Cross-sectional analyses examine plan participation in 2008, 2011, and 2012. First difference analyses examine changes in plan participation from 2008-2011 and 2011-2012.KEY RESULTS: A change in the relative benchmark rate (the ratio of the county-level Medicare Advantage benchmark rate to average costs under traditional fee-for-service Medicare) between 2008 and 2011 of two standard deviations below the mean change – a 10.1 percentage point decrease in the relative benchmark rate – was associated with a 2 percentage point lower predicted probability of a plan entering relative to never entering a county between 2008 and 2011 (predicted probability [PP] 0.67, 95% CI 0.67-0.67, p<.001), as compared to the predicted probability of plan entry at the mean change in the relative benchmark rate (PP 0.69, 95% CI 0.69-0.69, p<.001), and was associated with a 5 percentage point increase in the predicted probability of a plan exiting relative to staying in a county between 2008 and 2011 (PP 0.90, 95% CI 0.87-0.90, p<.001), as compared to the predicted probability of plan exit at the mean change in the relative benchmark rate (PP 0.85, 95% CI 0.85-0.88, p<.001).Plan profit status, local rates of employer-sponsored retiree coverage and Medicaid supplemental insurance coverage, hospital market concentration, and a parent company’s participation in the local non-Medicare managed care market were also found to be statistically significantly associated with plan participation. CONCLUSION: County-level Medicare Advantage benchmark rates are, in fact, associated with plan participation, but the magnitude of the association may be lower than is commonly thought.