Division of Research, Kaiser Permanente Northern California, Oakland.
Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island.
JAMA Netw Open. 2024 Jun 3;7(6):e2415058. doi: 10.1001/jamanetworkopen.2024.15058.
In 2018, the US Congress gave Medicare Advantage (MA) historic flexibility to address members' social needs with a set of Special Supplemental Benefits for the Chronically Ill (SSBCIs). In response, the Centers for Medicare & Medicaid Services expanded the definition of primarily health-related benefits (PHRBs) to include nonmedical services in 2019. Uptake has been modest; MA plans cited a lack of evidence as a limiting factor.
To evaluate the association between adopting the expanded supplemental benefits designed to address MA enrollees' nonmedical and social needs and enrollees' plan ratings.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study compared the plan ratings of MA enrollees in plans that adopted an expanded PHRB, SSBCI, or both using difference-in-differences estimators with MA Consumer Assessment of Health Care Providers and Systems survey data from March to June 2017, 2018, 2019, and 2021 linked to Medicare administrative claims and publicly available benefits and enrollment data. Data analysis was performed between April 2023 and March 2024.
Enrollees in MA plans that adopted a PHRB and/or SSBCI in 2021.
Enrollee plan rating on a 0- to 10-point scale, with 0 indicating the worst health plan possible and 10 indicating the best health plan possible.
The study sample included 388 356 responses representing 467 MA contracts and 2558 plans in 2021. Within the weighted population of responders, the mean (SD) age was 74.6 (8.7) years, 57.2% were female, 8.9% were fully Medicare-Medicaid dual eligible, 74.6% had at least 1 chronic medical condition, 13.7% had not graduated high school, 9.7% were helped by a proxy, 45.1% reported fair or poor physical health, and 15.6% were entitled to Medicare due to disability. Adopting both a new PHRB and SSBCI benefit in 2021 was associated with an increase of 0.22 out of 10 points (95% CI, 0.4-4.0 points) in mean enrollee plan ratings. There was no association between adoption of only a PHRB (adjusted difference, -0.12 points; 95% CI, -0.26 to 0.02 points) or SSBCI (adjusted difference, 0.09 points; 95% CI, -0.03 to 0.21 points) and plan rating.
Medicare Advantage plans that adopted both benefits saw modest increases in mean enrollee plan ratings. This evidence suggests that more investments in supplemental benefits were associated with improved plan experiences, which could contribute to improved plan quality ratings.
2018 年，美国国会赋予医疗保险优势计划（MA）一项历史性的灵活性，通过一系列针对慢性病患者的特殊补充福利（SSBCIs）来满足成员的社会需求。作为回应，医疗保险和医疗补助服务中心在 2019 年扩大了主要与健康相关的福利（PHRBs）的定义，将非医疗服务纳入其中。然而，这种福利的采用情况较为温和；MA 计划表示缺乏证据是一个限制因素。
评估采用旨在满足 MA 参保者非医疗和社会需求的扩大补充福利与参保者计划评级之间的关联。
设计、设置和参与者：本队列研究使用差异中的差异估计器比较了在 2021 年采用扩大后的 PHRB、SSBCI 或两者的 MA 参保者的计划评级，使用了 MA 消费者评估医疗保健提供者和系统调查数据，这些数据来自 2017 年 3 月至 6 月、2018 年、2019 年和 2021 年，并与医疗保险行政索赔和公开可用的福利和参保数据相关联。数据分析于 2023 年 4 月至 2024 年 3 月之间进行。
在 2021 年采用 PHRB 和/或 SSBCI 的 MA 计划的参保者。
参保者在 0 到 10 分制的计划评级，0 表示可能的最差健康计划，10 表示可能的最佳健康计划。
研究样本包括 388356 份回应，代表了 2021 年的 467 份 MA 合同和 2558 份计划。在加权回应人群中，平均（SD）年龄为 74.6（8.7）岁，57.2%为女性，8.9%为完全医疗保险-医疗补助双重资格，74.6%至少有一种慢性疾病，13.7%未完成高中学业，9.7%由代理人提供帮助，45.1%报告身体状况一般或较差，15.6%因残疾而有资格获得医疗保险。在 2021 年同时采用新的 PHRB 和 SSBCI 福利与参保者计划评级提高了 0.22 分（95%CI，0.4-4.0 分）。仅采用 PHRB（调整差异，-0.12 分；95%CI，-0.26 至 0.02 分）或 SSBCI（调整差异，0.09 分；95%CI，-0.03 至 0.21 分）与计划评级之间没有关联。
采用这两项福利的医疗保险优势计划的参保者的平均计划评级略有提高。这一证据表明，更多的补充福利投资与改善计划体验有关，这可能有助于提高计划质量评级。
