comparing quality in medicare ffs and medicare advantage
DESCRIPTION
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 PresentationTRANSCRIPT
![Page 1: Comparing Quality in Medicare FFS and Medicare Advantage](https://reader035.vdocuments.net/reader035/viewer/2022062316/568166ef550346895ddb4a39/html5/thumbnails/1.jpg)
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](https://reader035.vdocuments.net/reader035/viewer/2022062316/568166ef550346895ddb4a39/html5/thumbnails/2.jpg)
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](https://reader035.vdocuments.net/reader035/viewer/2022062316/568166ef550346895ddb4a39/html5/thumbnails/3.jpg)
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](https://reader035.vdocuments.net/reader035/viewer/2022062316/568166ef550346895ddb4a39/html5/thumbnails/4.jpg)
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](https://reader035.vdocuments.net/reader035/viewer/2022062316/568166ef550346895ddb4a39/html5/thumbnails/5.jpg)
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](https://reader035.vdocuments.net/reader035/viewer/2022062316/568166ef550346895ddb4a39/html5/thumbnails/6.jpg)
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](https://reader035.vdocuments.net/reader035/viewer/2022062316/568166ef550346895ddb4a39/html5/thumbnails/7.jpg)
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](https://reader035.vdocuments.net/reader035/viewer/2022062316/568166ef550346895ddb4a39/html5/thumbnails/8.jpg)
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](https://reader035.vdocuments.net/reader035/viewer/2022062316/568166ef550346895ddb4a39/html5/thumbnails/9.jpg)
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](https://reader035.vdocuments.net/reader035/viewer/2022062316/568166ef550346895ddb4a39/html5/thumbnails/10.jpg)
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](https://reader035.vdocuments.net/reader035/viewer/2022062316/568166ef550346895ddb4a39/html5/thumbnails/11.jpg)
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](https://reader035.vdocuments.net/reader035/viewer/2022062316/568166ef550346895ddb4a39/html5/thumbnails/12.jpg)
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](https://reader035.vdocuments.net/reader035/viewer/2022062316/568166ef550346895ddb4a39/html5/thumbnails/13.jpg)
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](https://reader035.vdocuments.net/reader035/viewer/2022062316/568166ef550346895ddb4a39/html5/thumbnails/14.jpg)
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](https://reader035.vdocuments.net/reader035/viewer/2022062316/568166ef550346895ddb4a39/html5/thumbnails/15.jpg)
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