Medicare Advantage and Fee-for-Service Performance on Clinical Quality and Patient Experience Measures

Comparisons from Three Large States

Published in: Health Services Research, Volume 52, Issue 6 (December 2017), Pages 2038-2060. doi: 10.1111/1475-6773.12787

Posted on RAND.org on March 22, 2018

by Justin W. Timbie, Andy Bogart, Cheryl L. Damberg, Marc N. Elliott, Ann C. Haas, Sarah J. Gaillot, Elizabeth Goldstein, Susan M. Paddock

Read More

Access further information on this document at Health Services Research

This article was published outside of RAND. The full text of the article can be found at the link above.

Objective

To compare performance between Medicare Advantage (MA) and Fee-for-Service (FFS) Medicare during a time of policy changes affecting both programs.

Data Sources/Study Setting

Performance data for 16 clinical quality measures and 6 patient experience measures for 9.9 million beneficiaries living in California, New York, and Florida.

Study Design

We compared MA and FFS performance overall, by plan type, and within service areas associated with contracts between CMS and MA organizations. Case mix-adjusted analyses (for measures not typically adjusted) were used to explore the effect of case mix on MA/FFS differences.

Data Collection/Extraction Methods

Performance measures were submitted by MA organizations, obtained from the nationwide fielding of the Medicare Consumer Assessment of Healthcare Providers and Systems (MCAHPS) Survey, or derived from claims.

Principal Findings

Overall, MA outperformed FFS on all 16 clinical quality measures. Differences were large for HEDIS measures and small for Part D measures and remained after case mix adjustment. MA enrollees reported better experiences overall, but FFS beneficiaries reported better access to care. Relative to FFS, performance gaps were much wider for HMOs than PPOs. Excluding HEDIS measures, MA/FFS differences were much smaller in contract-level comparisons.

Conclusions

Medicare Advantage/Fee-for-Service differences are often large but vary in important ways across types of measures and contracts.

This report is part of the RAND Corporation External publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

Our mission to help improve policy and decisionmaking through research and analysis is enabled through our core values of quality and objectivity and our unwavering commitment to the highest level of integrity and ethical behavior. To help ensure our research and analysis are rigorous, objective, and nonpartisan, we subject our research publications to a robust and exacting quality-assurance process; avoid both the appearance and reality of financial and other conflicts of interest through staff training, project screening, and a policy of mandatory disclosure; and pursue transparency in our research engagements through our commitment to the open publication of our research findings and recommendations, disclosure of the source of funding of published research, and policies to ensure intellectual independence. For more information, visit www.rand.org/about/principles.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.