A recent study published in the Journal of the American Medical Association Network Open explored differences in spending among Medicare Advantage (MA) and Medicare Shared Savings Program (MSSP) participants. This was a retrospective study of data from MA and MSSP beneficiaries at Ochsner Health, co-authored by Eboni Price-Haywood, MD, System Medical Director – Healthy State, Ochsner Health and Medical Director, Ochsner Xavier Institute for Health Equity & Research.
The objective of the study was to examine the difference in spending and utilization between the two Medicare programs and determine if increased spend could be attributed to measurable factors. It has long been acknowledged that differences likely exist; however, the root cause of the variance has yet to be identified.
“The unproven explanation for probable spending variances between the two Medicare plans for years has been demographic and clinical differences,” says Dr. Price-Haywood. “For this study, we worked with a group of economic analysists to develop a plan to review potential cost and savings differences between the two types of populations and determine if these differences can be measured and explained.”
Medicare claims and electronic health record (EHR) data from Ochsner Health between January 2014 to December 2018 were analyzed. In total, 15,763 data records were examined, including 12,720 MA and 3,043 MSSP beneficiaries. The study design identified beneficiaries with similar clinical characteristics and created four cohorts based on common, high-cost diseases - hypertension, diabetes, congestive heart failure, and chronic kidney disease. The study also examined practice patterns and quality of care to ensure consistency across both plans, as well as reviewed demographic characteristics, clinical variables, and socioeconomic variables.
After analyzing data between January 2015 and May 2022, the study authors concluded that MA and MSSP beneficiaries in all four cohorts differed in several areas. MA beneficiaries were more likely to be older, white males, and were less likely than MSSP beneficiaries to be disabled, qualify for Medicaid, and live in a low-income zip code. As well, outpatient hospital spending contributed significantly to the higher MSSP spend and inpatient spending in all four cohorts was higher for MSSP.
Additionally, primary care spending was significantly lower for MSSP beneficiaries in three of the four cohorts.
Overall, the study found that the average per member per year (PMPY) spending was 22% to 26% higher for MSSP beneficiaries compared to MA beneficiaries. This difference was largely attributed to hospital outpatient spending for MSSP beneficiaries. Practice patterns and quality of care were similar across both groups, and clinical and socioeconomic factors were well accounted for. Despite properly addressing all potential variances, the study was not able to explain the root cause for greater spending among MSSP beneficiaries.
“I think many lessons are learned from this study of data. We must look at how to equalize the design of both programs so that regardless of which plan a beneficiary chooses, the level and quality of care is the same, and we’re meeting the needs of all patients,” said Dr. Price-Haywood. “More work needs to be done to measure and explain the behavior pattern differences seen between these two population groups. Some may be related to demographic or social determinants of health.”
Frameworks for Advancing Health Equity: Urban Health Outreach
May 9th 2024In the series debut episode of "Frameworks for Advancing Health Equity," Mary Sligh, CRNP, and Chelsea Chappars, of Allegheny Health Network, explain how the Urban Health Outreach program aims to improve health equity for individuals experiencing homelessness.
Listen
Breast Cancer Treatment Disparities Impact Survival Based on Race, Age, Socioeconomics
May 9th 2024A new study has linked racial and ethnic disparities with factors like age, income, and insurance to breast cancer treatment decline. Patients who received all treatments had better survival, highlighting the need for interventions to improve access and reduce disparities.
Read More
Tackling Health Inequality: The Power of Education and Experience
April 30th 2024To help celebrate and recognize National Minority Health Month, we are bringing you a special month-long podcast series with our Strategic Alliance Partner, UPMC Health Plan. Welcome to our final episode of this limited series and our conversation with Janine Jelks-Seale, MSPPM, director of health equity at UPMC Health Plan.
Listen
Shelly Lanning on How Employers Can Reduce Costs by Bridging Gaps in Women's Health Care
May 3rd 2024In a presentation at the Greater Philadelphia Business Coalition on Health Women’s Health Summit, Shelly Lanning, cofounder and president of Visana Health, addressed the need for comprehensive approaches in women’s health care and their coverage options.
Read More
Joanne Mizell: Lifestyle Modification Programs Take Holistic Aim at Metabolic Disease
May 1st 2024Joanne Mizell shares insurer strategies in addressing the escalating rates of metabolic diseases, highlighting the importance of holistic treatment methods like lifestyle modification programs, which integrate nutrition, physical activity, and community engagement.
Read More
Frameworks for Advancing Health Equity: Urban Health Outreach
May 9th 2024In the series debut episode of "Frameworks for Advancing Health Equity," Mary Sligh, CRNP, and Chelsea Chappars, of Allegheny Health Network, explain how the Urban Health Outreach program aims to improve health equity for individuals experiencing homelessness.
Listen
Breast Cancer Treatment Disparities Impact Survival Based on Race, Age, Socioeconomics
May 9th 2024A new study has linked racial and ethnic disparities with factors like age, income, and insurance to breast cancer treatment decline. Patients who received all treatments had better survival, highlighting the need for interventions to improve access and reduce disparities.
Read More
Tackling Health Inequality: The Power of Education and Experience
April 30th 2024To help celebrate and recognize National Minority Health Month, we are bringing you a special month-long podcast series with our Strategic Alliance Partner, UPMC Health Plan. Welcome to our final episode of this limited series and our conversation with Janine Jelks-Seale, MSPPM, director of health equity at UPMC Health Plan.
Listen
Shelly Lanning on How Employers Can Reduce Costs by Bridging Gaps in Women's Health Care
May 3rd 2024In a presentation at the Greater Philadelphia Business Coalition on Health Women’s Health Summit, Shelly Lanning, cofounder and president of Visana Health, addressed the need for comprehensive approaches in women’s health care and their coverage options.
Read More
Joanne Mizell: Lifestyle Modification Programs Take Holistic Aim at Metabolic Disease
May 1st 2024Joanne Mizell shares insurer strategies in addressing the escalating rates of metabolic diseases, highlighting the importance of holistic treatment methods like lifestyle modification programs, which integrate nutrition, physical activity, and community engagement.
Read More
2 Commerce Drive
Cranbury, NJ 08512