Which Medicare Advantage Enrollees Are at Highest One-Year Mortality Risk?

Background

While a number of tools exist to predict mortality among older adults, less research has described the characteristics of Medicare Advantage (MA) enrollees at higher risk for 1 year mortality.

Objectives

To describe the characteristics of MA enrollees at higher mortality risk using patient survey data.

Research Design

Retrospective cohort.

Subjects

MA enrollees completing the 2019 MA Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey.

Measures

Linked demographic, health, and mortality data from a sample of MA enrollees were used to predict 1-year mortality risk and describe enrollee characteristics across levels of predicted mortality risk.

Results

The mortality model had a 0.80 c-statistic. Mortality risks were skewed: 6% of enrollees had a ≥10% 1-year mortality risk, while 45% of enrollees had 1% to <5% 1-year mortality risk. Among the high-risk (≥10%) group, 47% were age 85+ versus 12% among those with mortality risk <5%. 79% were in fair or poor self-rated health versus 29% among those with mortality risk of <5%. 71% reported needing urgent care in the prior 6 months versus 40% among those with a mortality risk of 1 to <5%.

Conclusions

Relatively few older adults enrolled in MA are at high 1-year mortality risk. Nonetheless, MA enrollees over age 85, in fair or poor health, or with recent urgent care needs are far more likely to be in a high mortality risk group.