1 / 15

Comparing Quality in Medicare FFS and Medicare Advantage

Comparing Quality in Medicare FFS and Medicare Advantage. Mark Shepard Harvard University Heritage Foundation Briefing June 28, 2011. Context for MA-FFS Comparison. Mandate in MIPPA to compare quality in MA and FFS starting this year.

nile
Download Presentation

Comparing Quality in Medicare FFS and Medicare Advantage

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Comparing Quality in Medicare FFS and Medicare Advantage Mark Shepard Harvard University Heritage Foundation Briefing June 28, 2011

  2. Context for MA-FFS Comparison • Mandate in MIPPA to compare quality in MA and FFS starting this year. • Quality comparisons are a potential tool for beneficiaries making enrollment choices. • Build on quality comparisons among plans when select MA plan on Medicare Plan Finder website. • Little previous work comparing the programs on quality of care because of data availability. • Goal: Compare MA and FFS nationally using identical measures, constructed as similarly as possible.

  3. Data and Methods • MA: HEDIS data publicly reported for 2006-07, pooled to form national quality rate • Exclude PFFS plans due to data availability • FFS: National measures for 2006-07 calculated from Medicare claims by CMS (GEM project) • Based on administrative HEDIS specifications • Statistically adjust for different geographic distribution of MA and FFS beneficiaries

  4. Quality Measures • 11 HEDIS measures of appropriate preventive screenings and medication management

  5. Results: FFS vs. MA Quality, 2007

  6. Results: FFS vs. MA Quality, 2007

  7. Results: FFS vs. MA Quality, 2007

  8. Results: FFS vs. MA Quality, 2007

  9. Interpreting MA-FFS Differences FFS Higher/Close (3) MA Higher Quality (8) • All newer in HEDIS: introduced 2004-2005 • Improved rapidly in MA from 2006 to 2007; also in 2008-2009 • All “well-established” in HEDIS: since 1990s • Declined in quality in MA from 2006 to 2007 • Suggested Explanation: MA “Learning Effect”

  10. Older and Newer Measures in MA Averages calculated from NCQA, State of Health Care Quality, 2010

  11. Limitations of MA-FFS Comparison • Population Differences • Beneficiaries who choose MA may be easier/ harder to deliver appropriate care. • Measurement Differences • FFS has only claims data, while MA plans can also use chart review (hybrid measures). • Additional research needed to address these limitations.

  12. Results: MA Distribution vs. FFS

  13. Results: MA Distribution vs. FFS

  14. Results: MA Distribution vs. FFS

  15. Conclusions • MA better on 9 of 11measures • Much better on 8 measures, slightly better or worse than FFS on 3 measures • MA performed best on older HEDIS measures, worst on the newer measures. • Suggested explanation: MA plan learning effect • Substantial differences in absolute terms, but even larger variation across MA plans

More Related