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 High-Need Medicare Advantage Members Disenroll at Higher Rates: Study

​Research published in JAMA Internal Medicine says high-need Medicare beneficiaries and those dually eligible (dual-eligibles) for both Medicare and Medicaid were much more likely to disenroll from Medicare Advantage (MA) plans than other beneficiaries. Increasingly, long term and post-acute care providers are becoming active in the MA space.

Findings also suggest that MA plan star ratings have the strongest association with disenrollment trends, but increases in monthly premiums are tied to the greater likelihood of switching plans within the MA universe.

The research by Brown University and Columbia University academics is titled, “Analysis of Drivers of Disenrollment and Plan Switching Among Medicare Advantage Beneficiaries,” and was undertaken to find out to what extent high-need Medicare beneficiaries switch to and from MA plans, and what influences these decisions.
By definition, the Centers for Medicare & Medicaid Services says adults categorized as high-need are individuals who have three or more chronic diseases and a functional limitation in activities of daily living or in performing routine daily tasks.
The findings come from a study of more than 15.9 million MA enrollees and showed that among high-need enrollees, 4.6 percent of Medicare-only and 14.8 percent of Medicare-Medicaid (duals) beneficiaries switched to traditional Medicare, compared with 3.3 percent and 4.6 percent, respectively, among non-high-need enrollees.
Among dual-eligible enrollees who began in traditional Medicare, 15 percent switched into MA, and plan quality ratings were associated with disenrollment, the research said.
Researchers said disenrollment from MA plans “may indicate that plans do not meet the preferences of enrollees with significant chronic illness and may complicate performance measurement and risk adjustment for MA plans.”
Among enrollees in low-quality plans, 23 percent of Medicare and 42.8 percent of dual-eligible high-need enrollees left MA.
“Even in high-quality plans, high-need members disenrolled at higher rates than non-high-need members (4.9 percent vs 1.8 percent) for Medicare-only enrollees and 11.3 percent vs 2.4 percent for dual-eligibles,” the report said. “Enrollment in a Five-Star-rated plan was associated with a 30.1-percentage point reduction in the probability of disenrollment among high-need individuals.”
And, the study said a $100 increase in monthly premiums was associated with a 33.9-percentage point increase in the likelihood of switching plans, and a small reduction in the likelihood of disenrolling (minus 2.7 percentage points). Among dual-eligible participants, 14.1 percent of high-need and 16.7 percent of non-high-need enrollees switched from traditional Medicare to MA.
The study took place with MA and traditional Medicare enrollees from Jan. 1, 2014, through Dec. 31, 2015. All 14.5 million non-high-need MA enrollees and 1.3 million high-need enrollees in the United States who survived until the end of 2014 were eligible for the analysis. Data were analyzed from Nov. 1, 2017, through Aug. 1, 2018, researchers said.
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