Cost and Quality Information in Medicare Advantage Enrollment Decisions

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1 Cost and Quality Information in Medicare Advantage Enrollment Decisions Rachel Reid, MD, MS 1 ; Partha Deb, PhD 2,3 ; Benjamin Howell, PhD 2 ; Patrick Conway 2,4, MD, MSc; William Shrank, MD, MSHS 1 Brigham and Women s Hospital, Dept. of Medicine; Centers for Medicare and Medicaid Services Center for Medicare and Medicaid Innovation; CUNY Hunter College, Dept. of Economics, Cincinnati Children's Hospital Medical Center, Division of Hospital Medicine AcademyHealth Annual Research Meeting Sunday, June 8, 2014

2 Medicare Advantage: A Health Insurance Marketplace Success of marketbased system relies on thoughtful htf consumer cost- benefit decisions CMS publishes costs, quality, and benefits via Medicare Plan Finder website Including 5-Star Quality Ratings

3 CMS Rates Medicare Advantage Plan Quality on a 5-Star Scale Based 50+ quality measures: Surveys (CAHPS, HOS), HEDIS, Administrative data (e.g., complaints, appeals, audits) Have garnered significant attention CMS providing bonuses and extended d open enrollment by rating Plans using ratings in marketing and provider networks changes Prior research has revealed association with enrollment

4 Plans and policymakers use ratings and data But do beneficiaries? Previous studies have demonstrated: Association between costs, benefits, and quality and enrollment choices and preferences in commercial market Numerous complex options can be challenging to interpret Study Objective: Assess associations i between plan attributes and enrollment Variation explained by plan attributes t Willingness to pay for quality

5 National Cross-sectional Analysis of Medicare Advantage Enrollments 2011 non-employer sponsored MAPD enrollments of beneficiaries enrolling in Medicare Advantage for 1 st time ever 1 st year of Combined Overall MAPD star-rating Precedes 2012 bonuses and open-enrollment extensions based on rating Matched beneficiaries with choice set of plans (by county) Excluded those deemed eligible for Low-Income Subsidy Excluded d those who could not be definitively i i mapped to a choice-set Excluded PACE, SNP, cost, MA stand-alone, employer-sponsored plans Data from: Integrated Data Repository (demographics and enrollments) Health Plan Management System (costs, benefits, service area) Public files (star-ratings)

6 Discrete Choice Approach Conditional i Logit Model Estimate association between plan attributes and enrollment Medicare Advantage Market Structure: Choose 1 plan from finite choice set Choice sets vary in number, content, and attributes Costs 5-Star Quality Rating Market Share Other benefits Bene. Sub- groups Health and Drug Plan Premiums Average estimated combined OOP costs Rating itself Quadratic transform Indicator for Unrated Plans Sponsor organization market share Plan type (e.g., HMO, PPO) Co-insurance Deductibles Vision, Hearing, Dental, Rx Gap Coverage Age Sex Race/Ethnicity Urban/Rural Residence

7 Analyses Based on Conditional Logistic Regression Model Proportion of Variation from Plan Attributes Willingness to Pay for Quality Cumulative explained variance from covariates Cumulative explained variance from model Ratio of marginal utility of increased rating to marginal utility of increased cost Marginal Willingness to Pay increase in total annual OOPC & premiums for next rating Cumulative Willingness to Pay for plan at each rating by summing margins with base

8 Characteristic n (%) Total 847,069 Age Less than 64 yr 145,612 (17.2%) Sex yr 361,914 (42.7%) yr 188,879 (22.3%) 71 or greater yr 150,664 (17.8%) Study Cohort: Female 455,731 (53.8%) Male 391,338 (46.2%) Race/Ethnicity White 646,430 (76.3%) Black 77,262 (9.1%) Hispanic 68,769 (8.1%) Other 54,608 (6.4%) Urban vs. rural residence Rural ,376 (17.0%) Urban 702,693 (83.0%) Region Northeast 153,005 (18.1%) South 312,829 (36.9%) Midwest 168,530 (19.9%) West 212,705 (25.1%) No. of plans in choice-set, mean (range) All Plans 16.5 (2-48) Rated Plans 13.1 (1-42) Rated 4+ Stars 2.1 (0-15) 1 st -time Mdi Medicare Advantage Enrollees in 2011

9

10 Beneficiaries Willing to Pay More for Higher-Rated Plans OOPC to Pay ms and O ingness t al Premiu Willi m. Annua Cum $6,000 $5,000 $4,000 $3,000 $2,000 $1,000 $0 $5,630 $5,699 $5,441 $5,133 $4,704 $4,503 $4,155 Unrated Star 3-Star Star 4-Star Star 5-Star Plan 5-Star Quality Rating

11 But Exhibit Diminishing Marginal Utility for Quality d OOPC to Pay ums and ingness t al Premiu Willi m. Annua Cum $6,000 $5,000 $4,000 $3,000 $2,000 $1,000 $0 $188 $68 $309 $429 $549 $348 Unrated Star 3-Star Star 4-Star Star 5-Star Plan 5-Star Quality Rating

12 Willingness to Pay for Quality by Subgroup $6,000 $5,000 Pay Wi illingness to $4,000 $3,000 $2,000 $1,000 $- Plan 5-Star Quality Rating <64 y 64-65y 66-70y 71y + Overall

13 Willingness to Pay for Quality by Beneficiaries aged 64-65y65y More Willing to Pay Subgroup $6,000 $5,000 Pay Wi illingness to $4,000 $3,000 $2,000 $1,000 $- Plan 5-Star Quality Rating <64 y 64-65y 66-70y 71y + Overall

14 Willingness to Pay for Quality by Subgroup Beneficiaries aged 64-65y65y More Willing to Pay No Difference in Willingness to Pay by Sex $6,000 $6,000 $5,000 $5,000 Pay Wi illingness to $4,000 $3,000 $2,000 Pay llingness to Wi $4,000 $3,000 $2,000 $1,000 $1,000 $- $- Plan 5-Star Quality Rating <64 y 64-65y 66-70y 71y + Overall Plan 5-Star Quality Rating Male Female Overall

15 Willingness to Pay for Quality by Black Beneficiaries Less Willing to Pay Subgroup $6,000 $5,000 Pay llingness to Wi $4,000 $3,000 $2,000 $1,000 $- Plan 5-Star Quality Rating White Black Hispanic Other Overall

16 Willingness to Pay for Quality by Subgroup Black Beneficiaries Less Willing to Pay Urban Residents More Willing to Pay $6,000 $6,000 $5,000 $5,000 Pay llingness to Wi $4,000 $3,000 $2,000 Pay llingness to Wi $4,000 $3,000 $2,000 $1,000 $1,000 $- $- Plan 5-Star Quality Rating Plan 5-Star Quality Rating White Black Hispanic Other Overall Urban Rural Overall

17 Summary Costs and quality both explain some variation. Brand market share is also prominent. Costs explain more than 2x variation explained by quality Market share likely encompasses multiple things: Brandrecognition, word-of-mouth, additional unobservables Beneficiaries are willing to pay for quality. Exhibit diminishing marginal utility for quality Magnitude varies among key subgroups

18 Limitations Cross sectional design prohibits causal inferences Assess only 1 year of enrollments Generalizability limited for extant enrollees, low-income, or beneficiaries in PACE, SNP, employer-sponsored or MA stand-alone plans C t i t f i di id l i h lth Cannot assess impact of individual income, health status, or utilization

19 Policy Implications Opportunities i to rebalance factors contributing i to choices Highest-quality or highest-value plan may not be right plan for all Challenging to know what degree of influence of market share is appropriate Continued efforts to highlight plan features and inform choices Diminishing marginal utility for quality justifies policies for higher rated plans Differential willingness to pay for quality by key subgroups More research needed d to understand: d Dimensions of quality and measures most important Mechanisms of communication most efficacious Similar 5-Star Quality program likely to be used in Federal Marketplace

20 Thank You! Questions?

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