Senior-Focused Primary Care Organizations Increase Access For Medicare Advantage Members, Especially Underserved...

Area of Science:

• Health Services Research
• Healthcare Policy
• Health Equity

Background:

• Population-based payment models in Medicare Advantage (MA) incentivize providers to innovate care delivery.
• These models can potentially improve care for underserved populations where healthcare costs often exceed reimbursement.
• Senior-focused primary care organizations are increasingly adopting these payment structures.

Purpose of the Study:

• To investigate the association between population-based payment models and care quality/equity in MA.
• To compare senior-focused primary care organizations with other MA primary care organizations receiving different payment structures.
• To assess the impact on access and utilization for historically underserved groups.

Main Methods:

• Analysis of data from 462,872 MA beneficiaries in 2021.
• Comparison of senior-focused primary care organizations (predominantly population-based payments) with other primary care organizations.
• Regression-adjusted analyses to evaluate differences in care and equity.

Main Results:

• Senior-focused primary care organizations served a higher proportion of Black and dually eligible beneficiaries.
• Patients in senior-focused organizations received 17% more primary care visits compared to other MA patients.
• These disparities in enhanced care and access were most pronounced among Black and dually eligible beneficiaries.

Conclusions:

• Risk-bearing organizations within MA are adapting to payment dynamics by enhancing care and access.
• Population-based payment models appear to be associated with improved care delivery and equity for underserved populations.
• Further research into these payment models can inform strategies to reduce health disparities in MA.