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Dual Eligibles in Medicare Advantage Faced Fewer COVID-Related Disruptions in Care [PODCAST]

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The Hospital Finance Podcast

In this episode, we are joined by Caroline Pearson, Senior Vice President at NORC, to discuss how dual eligible beneficiaries enrolled in Medicare Advantage were less likely to experience disruptions in their healthcare during the COVID-19 pandemic

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Highlights of this episode include:

  • What are dual eligible beneficiaries
  • Medicare Advantage versus fee-for-service Medicare
  • How dual eligibles did during the pandemic depending on enrollment type
  • Future of Medicare Advantage

Mike Passanante: Hi. This is Mike Passanante, and welcome back to the award-winning Hospital Finance Podcast. According to a new analysis from NORC at the University of Chicago, dual eligible beneficiaries enrolled in Medicare Advantage were less likely to experience disruptions in their healthcare during the COVID-19 pandemic than dual eligibles enrolled in traditional fee-for-service Medicare. To explain this finding, I’m joined by Caroline Pearson, senior vice president at NORC. Caroline, welcome back to the show.

Caroline Pearson: Hi, Mike. Thanks so much for having me.

Mike: So first, for those who may not be familiar with NORC, can you explain what you do there?

Caroline: Yeah. NORC is a nonprofit objective research institution closely affiliated with the University of Chicago, and I run our healthcare strategy team where we look at research and data analysis to inform healthcare decision-makers.

Mike: Wonderful. And this study piqued my interest because there is such a growth in Medicare Advantage, and I think it’s interesting to see where trends are going in terms of care for patients in that program. So in this analysis, you looked at access to care for dual eligibles during the COVID-19 pandemic, as we mentioned. Can you start out by explaining what dual eligibles are and what led you to look at the difference between those enrolled in traditional Medicare versus Medicare Advantage?

Caroline: Absolutely. So dual eligible beneficiaries are some of the lowest income Medicare beneficiaries. So Medicare is the program that serves seniors and people with disability. Dual eligible beneficiaries are also enrolled in Medicaid, which is the program for low-income individuals. And so these are a particularly vulnerable set of the Medicare population. They tend to be reasonably complex in terms of health needs. And so they’re an important focus to understand how the Medicare program and Medicare Advantage plans can begin to serve this population better.

Mike: And what led you to take a look at that specifically? What piqued your interest in terms of Medicare Advantage versus fee-for-service Medicare?

Caroline: Yeah. So over time, we have seen a tremendous and consistent growth in enrollment in Medicare Advantage. And historically, the conventional wisdom has been, oh, Medicare Advantage, which is the private plans that administer Medicare. Medicare Advantage is enrolling younger, healthier patients or beneficiaries, folks that have spent most of their life with employer coverage and are most comfortable in private plans. And so we’ve had this hypothesis that they were really a fundamentally different population. What has changed in the last several years is Medicare Advantage plans have really begun to focus on providing care for more complicated and higher needs enrollees. And so the first thing that I wanted to look at in this data was to really understand what’s the difference in the demographics of duals who are enrolled in fee-for-service versus those who are selecting Medicare Advantage. And the results were quite striking. So we actually found that dual eligibles in Medicare Advantage were much older, much less likely to be white. So they were more likely to be Hispanic and black. And they had statistically significantly more chronic conditions. So this is a population that’s older, sicker, and has more minority representation, and therefore really needs some special focus from the MA plans that serve them.

Mike: Okay. So let’s dive into some of the specifics that you found. What were some of the biggest findings there?

Caroline: Yeah. So starting with the notion that the enrollees in Medicare Advantage are actually higher needs, we then wanted to say, “Okay, how did folks do during the pandemic?” We know that the pandemic was a challenge for everyone in the country, but especially for older adults in terms of their ability to maintain access to care. And again, we might have thought that because the population was more complex and older that they might have had worse access to care during the pandemic, but we actually saw pretty consistent responses between the two groups about challenges accessing all types of care. And then when we looked specifically at sort of ongoing care, we saw that duals in Medicare Advantage plans fared better than duals in fee-for-service. So they’re less likely to report that they couldn’t get a regular checkup, that they couldn’t get ongoing care for a chronic condition, that they couldn’t access urgent care. And so all of those are really positive outcomes that suggest that Medicare Advantage plans may have been doing a good job at helping their enrollees understand how to access care, despite all of the disruptions of the pandemic.

Mike: Did any of that surprise you, Caroline?

Caroline: Yeah, it definitely surprised me. I mean, the typical assumption is the older folks, folks who are less likely to speak English at home, which is true of the duals in MA, people with health conditions, that they are the ones that are most likely to have experienced care disruptions in a challenged time like the pandemic. So we would expect that the MA enrollees might have done worse. The fact that they actually performed a bit better is really saying something and really does speak to the potential for Medicare Advantage plans to provide some ongoing continuity of care and care management as a service to their members.

Mike: So what do you think the implications are of this analysis? I’m just curious to see where you think it’s going. Obviously, Medicare Advantage has been growing. Do you think it’s going to grow more as a result of some of this? Do you think it gives them some leverage to move out? It sounds like it does.

Caroline: I think it does. I think Medicare Advantage is growing, and I think it’s going to continue to grow. There’s always a debate in Washington with policy-makers about whether the payments are right and sort of what kind of value we’re getting from Medicare Advantage plans. And I think these results begin to tell the story about how private plans are taking advantage of the payments that they get from the federal government to really provide a more coordinated, managed set of care for their enrollees, rather than fee-for-service, where beneficiaries are somewhat left to their own devices to figure out what they need and how to access the doctor. So everybody believes care management is important, and this is just a little bit more data that shows Medicare Advantage plans may be really contributing to that vision for better care.

Mike: And it appears they can do that for various subsections of the population. It’s not just contained in one area of our population.

Caroline: Absolutely. They’re not just doing it for high literacy, easy-to-manage groups. They’re doing it for some of the oldest and sickest populations, and those are the folks with the highest spending, so that’s the places in our health care system where better management has an opportunity to produce much better results, both in terms of spending and health outcomes.

Mike: Well, that’s a great story in the healthcare space. Something positive that’s coming out of all of this, maybe, so glad to hear about this. Caroline, if someone wanted to read about the detailed analysis, where can they go?

Caroline: You can find it on our website, which is, under the press releases tab.

Mike: Fantastic. Caroline Pearson, thanks so much for joining us again on the Hospital Finance Podcast.

Caroline: Thanks so much for having me. Have a great rest of your day.

The Hospital Finance Podcast

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