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Published on: February 16, 2011

Comparing quality of care in the Medicare program

Niall Brennan1, Mark Shepard

  • 1The Brookings Institution, Washington, DC, USA. niall.brennan@cms.hhs.gov

The American Journal of Managed Care
|February 26, 2011
PubMed
Abstract

Insights

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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