Comparing Quality in Medicare FFS and Medicare Advantage

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Comparing Quality in Medicare FFS and Medicare Advantage Mark Shepard Harvard University Heritage Foundation Briefing June 28, 2011

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Comparing Quality in Medicare FFS and Medicare Advantage. Mark Shepard Harvard University Heritage Foundation Briefing June 28, 2011. Context for MA-FFS Comparison. Mandate in MIPPA to compare quality in MA and FFS starting this year. - PowerPoint PPT Presentation

Transcript of Comparing Quality in Medicare FFS and Medicare Advantage

Page 1: Comparing Quality in Medicare  FFS  and Medicare Advantage

Comparing Quality in Medicare FFS and Medicare Advantage

Mark ShepardHarvard University

Heritage Foundation Briefing

June 28, 2011

Page 2: Comparing Quality in Medicare  FFS  and Medicare Advantage

Context for MA-FFS Comparison• Mandate in MIPPA to compare quality in

MA and FFS starting this year.• Quality comparisons are a potential tool for

beneficiaries making enrollment choices.▫ Build on quality comparisons among plans when

select MA plan on Medicare Plan Finder website.• Little previous work comparing the programs

on quality of care because of data availability.• Goal: Compare MA and FFS nationally using

identical measures, constructed as similarly as possible.

Page 3: Comparing Quality in Medicare  FFS  and Medicare Advantage

Data and Methods• MA: HEDIS data publicly reported for 2006-07,

pooled to form national quality rate▫Exclude PFFS plans due to data availability

• FFS: National measures for 2006-07 calculated from Medicare claims by CMS (GEM project)▫Based on administrative HEDIS specifications

•Statistically adjust for different geographic distribution of MA and FFS beneficiaries

Page 4: Comparing Quality in Medicare  FFS  and Medicare Advantage

Quality Measures• 11 HEDIS measures of appropriate preventive

screenings and medication management

Diabetes• HbA1c tests• Eye exams• LDL testing• Nephropathy screening/ med. attention

Heart Disease• LDL Testing• Beta Blockers After Heart Attack• Persistence on Beta Blockers for 6 months

Other• Breast Cancer Screening• Antidepressant Management• Anti-Rheumatic Drug Therapy• Monitoring for persistent meds.

Page 5: Comparing Quality in Medicare  FFS  and Medicare Advantage

Results: FFS vs. MA Quality, 2007

Antidepressant

Breast Cancer

Anti-Rheumatic

Persistent Meds

Persist. On BB

LDL Test

Beta Blockers*

Eye Exam

Nephro.

LDL Test

HbA1c

50% 60% 70% 80% 90% 100%

FFS

* 2006 Data

Dia

bete

sH

eart

D

isea

seO

ther

Page 6: Comparing Quality in Medicare  FFS  and Medicare Advantage

Results: FFS vs. MA Quality, 2007

Antidepressant

Breast Cancer

Anti-Rheumatic

Persistent Meds

Persist. On BB

LDL Test

Beta Blockers*

Eye Exam

Nephro.

LDL Test

HbA1c

50% 60% 70% 80% 90% 100%

FFSMA

* 2006 Data

Dia

bete

sH

eart

D

isea

seO

ther

+4.4%

+6.5%

+7.8%

+5.2%

Page 7: Comparing Quality in Medicare  FFS  and Medicare Advantage

Results: FFS vs. MA Quality, 2007

Antidepressant

Breast Cancer

Anti-Rheumatic

Persistent Meds

Persist. On BB

LDL Test

Beta Blockers*

Eye Exam

Nephro.

LDL Test

HbA1c

50% 60% 70% 80% 90% 100%

FFSMA

* 2006 Data

Dia

bete

sH

eart

D

isea

seO

ther

+4.4%

+6.5%

+7.8%

+5.2%

+6.8%

+7.3%

-5.0%

Page 8: Comparing Quality in Medicare  FFS  and Medicare Advantage

Results: FFS vs. MA Quality, 2007

Antidepressant

Breast Cancer

Anti-Rheumatic

Persistent Meds

Persist. On BB

LDL Test

Beta Blockers*

Eye Exam

Nephro.

LDL Test

HbA1c

50% 60% 70% 80% 90% 100%

FFSMA

* 2006 Data

Dia

bete

sH

eart

D

isea

seO

ther

+4.4%

+6.5%

+7.8%

+5.2%

+6.8%

+7.3%

-5.0%

-3.4%

+1.4%

+14.5%

+14.5%

Page 9: Comparing Quality in Medicare  FFS  and Medicare Advantage

Interpreting MA-FFS DifferencesMA Higher Quality (8)

• All “well-established” in HEDIS: since 1990s

• Declined in quality in MA from 2006 to 2007

• All newer in HEDIS: introduced 2004-2005

• Improved rapidly in MA from 2006 to 2007; also in 2008-2009

FFS Higher/Close (3)

Suggested Explanation: MA “Learning Effect”

Page 10: Comparing Quality in Medicare  FFS  and Medicare Advantage

Older and Newer Measures in MA

2006 2007 2008 200972%

74%

76%

78%

80%

82%

Qua

lity

Rat

e

Avg. of 3 Newer Measures

Avg. of 8 Older Measures

Averages calculated from NCQA, State of Health Care Quality, 2010

Page 11: Comparing Quality in Medicare  FFS  and Medicare Advantage

Limitations of MA-FFS Comparison•Population Differences

▫Beneficiaries who choose MA may be easier/ harder to deliver appropriate care.

•Measurement Differences▫FFS has only claims data, while MA plans

can also use chart review (hybrid measures).

•Additional research needed to address these limitations.

Page 12: Comparing Quality in Medicare  FFS  and Medicare Advantage

Results: MA Distribution vs. FFS

Natl. FFS Avg. Natl. MA Avg.

05

1015

Per

cent

.4 .5 .6 .7 .8 .9 1Quality Rate

MA Plan Distribution: Breast Cancer Screening, 2007

Page 13: Comparing Quality in Medicare  FFS  and Medicare Advantage

Results: MA Distribution vs. FFS

Natl. FFS Avg. Natl. MA Avg.

05

10P

erce

nt

.2 .3 .4 .5 .6 .7 .8 .9 1Quality Rate

MA Plan Distribution: Diabetes Eye Exams, 2007

Page 14: Comparing Quality in Medicare  FFS  and Medicare Advantage

Results: MA Distribution vs. FFS

Natl. FFS Avg.Natl. MA Avg.

05

1015

Per

cent

.4 .5 .6 .7 .8 .9 1Quality Rate

MA Plan Distribution: Persistence of Beta Blockers, 2007

Page 15: Comparing Quality in Medicare  FFS  and Medicare Advantage

Conclusions• MA better on 9 of 11 measures

▫Much better on 8 measures, slightly better or worse than FFS on 3 measures

•MA performed best on older HEDIS measures, worst on the newer measures.▫Suggested explanation: MA plan learning effect

•Substantial differences in absolute terms, but even larger variation across MA plans