Differences between integrated and non-integrated plans in Medicare Advantage.

OBJECTIVE

To understand differences in financial performance, quality performance, supplemental benefits provision, and enrollee composition between integrated and non-integrated plans in the Medicare Advantage (MA) program.

DATA SOURCES

We used data from the Center for Medicare and Medicaid Services for 2015-2017. We included 156 integrated MA plans (31 unique contracts) and 2096 non-integrated MA plans (392 unique contracts).

STUDY DESIGN

We estimated linear probably models for financial performance, quality performance, supplemental benefits provision, and enrollee composition with state fixed effects and contract random effects. We adjusted for county-level market structure-related factors, cost-related factors, and demand-related factors. Our primary independent variable was an indicator of plan-provider integration.

PRINCIPAL FINDINGS

Integrated MA plans were associated with $19.4 (95% CI: 9.2, 29.7) and $16.6 (95% CI: 10.3, 22.9) higher Part C and Part D monthly premiums, but were associated with higher star quality ratings. There were no significant differences in revenues and plan payments per enrollee between integrated and non-integrated MA plans. Integrated MA plans were associated with $40.5 (95% CI: -54.0, -26.9) lower non-claims costs than non-integrated MA plans. There was limited evidence that integrated MA plans provided more generous supplemental benefits than non-integrated MA plans. Enrollment rates in integrated MA plans were particularly low among socially marginalized groups (3.4 [95% CI: -5.9, -1.0], 4.7 [95% CI: -8.5, -0.9], and 4.4 [95% CI: -6.4, -2.4] percentage points lower among non-Hispanic Black, Medicare-Medicaid dual eligible, and the disabled).

CONCLUSIONS

Our findings suggest that integrated MA plans may achieve higher efficiency and quality, but these benefits may not be experienced by all beneficiaries due to disparities in enrollment. As these models continue to spread, it is critical to develop policies to ensure that MA enrollees have equal access to integrated plans.