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Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care
Published on: February 16, 2011
Comparing quality of care in the Medicare program
1The Brookings Institution, Washington, DC, USA. niall.brennan@cms.hhs.gov
The American Journal of Managed Care
|February 26, 2011
Summary
Medicare Advantage (MA) plans generally showed higher quality of care than Medicare fee-for-service (FFS) on established measures. Newer measures revealed mixed results, suggesting a learning effect for MA plans over time.
Area of Science:
- Health Services Research
- Quality Improvement
- Healthcare Policy
Background:
- Medicare is a federal health insurance program for people aged 65 or older, and some younger people with disabilities.
- Medicare fee-for-service (FFS) is the traditional payment model, while Medicare Advantage (MA) is a managed care option.
- Comparing the clinical quality of care between these two Medicare models is crucial for understanding healthcare delivery and patient outcomes.
Purpose of the Study:
- To compare the clinical quality of care provided by Medicare Advantage (MA) managed care plans versus the traditional Medicare fee-for-service (FFS) program.
- To identify differences in quality performance across various healthcare domains.
- To inform policy decisions regarding Medicare program structures and quality measurement.
Main Methods:
- A nationwide comparison of 11 Healthcare Effectiveness Data and Information Set (HEDIS) quality measures for MA plans and the FFS program.
- Data collected for the years 2006 and 2007.
- Adjustment of FFS measures to align with the geographic distribution of MA enrollment.
Main Results:
- Medicare Advantage plans demonstrated substantially better performance on 8 established HEDIS measures (median 7.8 percentage points higher).
- MA plans showed slightly better performance on 1 measure, but worse performance on 2 newer measures (median 4.1 percentage points lower).
- Observed differences were unlikely to be solely explained by data or program variations, suggesting genuine performance gaps.
Conclusions:
- Significant, albeit mixed, differences in clinical quality exist between MA and FFS programs.
- The superior performance on older measures and mixed results on newer ones suggest a potential learning effect in MA plans.
- MA plans may improve measurement and quality over time as they become more familiar with HEDIS measures.
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