title: High-Cost Patients Had Substantial Rates Of Leaving Medicare Advantage And Joining Traditional Medicare.
abstract: Medicare Advantage payment regulations include risk-adjusted capitated reimbursement, which was implemented to discourage favorable risk selection and encourage the retention of members who incur high costs. However, the extent to which risk-adjusted capitation has succeeded is not clear, especially for members using high-cost services not previously considered in assessments of risk selection. We examined the rates at which participants who used three high-cost services switched between Medicare Advantage and traditional Medicare. We found that the switching rate from 2010 to 2011 away from Medicare Advantage and to traditional Medicare exceeded the switching rate in the opposite direction for participants who used long-term nursing home care (17 percent versus 3 percent), short-term nursing home care (9 percent versus 4 percent), and home health care (8 percent versus 3 percent). These results were magnified among people who were enrolled in both Medicare and Medicaid. Our findings raise questions about the role of Medicare Advantage plans in serving high-cost patients with complex care needs, who account for a disproportionately high amount of total health care spending.
authors.affiliation: Momotazur Rahman (momotazur_rahman@brown.edu) is an assistant professor in the Department of Health Services, Policy, and Practice, School of Public Health, at Brown University, in Providence, Rhode Island.
authors.forename: Momotazur
authors.initials: M
authors.lastname: Rahman
authors.affiliation: Laura Keohane is an assistant professor in the Department of Health Policy at the Vanderbilt University School of Medicine, in Nashville, Tennessee.
authors.forename: Laura
authors.initials: L
authors.lastname: Keohane
authors.affiliation: Amal N. Trivedi is an associate professor in the Department of Health Services, Policy, and Practice, School of Public Health, and in the Department of Medicine, both at Brown University. He also is a core investigator in the Center of Innovation in Long Term Services and Supports at the Providence Veterans Affairs Medical Center, in Rhode Island.
authors.forename: Amal N
authors.initials: AN
authors.lastname: Trivedi
authors.affiliation: Vincent Mor is a professor in the Department of Health Services, Policy, and Practice, School of Public Health, at Brown University and a core investigator in the Center of Innovation in Long Term Services and Supports at the Providence VA Medical Center.
authors.forename: Vincent
authors.initials: V
authors.lastname: Mor
mesh_terms: D005102:Health Expenditures / Q000706:statistics & numerical data*; D006699:Home Care Services / Q000191:economics*; D006801:Humans; D008134:Long-Term Care / Q000191:economics*; D008484:Medicaid / Q000191:economics* / Q000706:statistics & numerical data*; D009735:Nursing Homes / Q000191:economics*; D014481:United States
keywords: Health Reform; Home Care; Long-Term Care; Managed Care - Medicare < Managed Care