MEDICARE ADVANTAGE MARKET DYNAMICS AND QUALITY: HISTORICAL CONTEXT AND CURRENT IMPLICATIONS

In this presentation, we assess variation in Medicare’s star quality ratings of Medicare Advantage (MA) plans that are available across geographic areas. Evidence from the recent Centers for Medicare & Medicaid Services (CMS) quality demonstration suggests that market dynamics, i.e., firms entering and exiting the MA marketplace, play a role in quality improvement. Therefore, we also discuss how market dynamics may impact the smaller and less wealthy populations that are characteristic of rural places, raising concenrs about equity and access to quality plans. Highly rated MA plans are more likely to be health maintenance organizations (HMOs) and local preferred provider organizations (PPOs), as opposed to regional PPOs. HMOs and local PPOs may be better able to improve their quality scores strategically in response to the bonus payment incentive. MA plans have lower quality ratings in rural areas on average. However, the rural enrollment rate is higher in plans with lower quality scores than in plans with high quality scores. This differential is likely due, in part, to lack of availability of highly rated plans in rural areas: 17.8 percent of rural counties lacked access to a plan with four or more (out of five) stars, while just 3.7 percent of urban counties lacked such access. MA plans with high quality scores have been operating longer, on average, and have a lower percentage of rural counties within their contract service areas than plans with lower quality scores. In 2015, 59.3 percent of rural MA beneficiaries were enrolled in a plan with at least four stars, compared to 71.1 percent of urban enrollees. This analysis is completed using a unique data set containg all MA plans across the U.S. For each MA plan, the quality scores are explored to explore the geographic variation of plans that offered.