A study recently published in JAMA Health Forum shows that people covered under Medicare Advantage (MA) have lower rates of low-value care than those covered by traditional Medicare (TM).
The cross-sectional study, published Sept. 9, examined the claims data of 2,470,199 Medicare beneficiaries, aiming to discover what rates of low-value care MA recipients received compared to traditional Medicare recipients and what aspects of these insurance programs may contribute to those rates. The claims data were from January 1, 2017 through December 31, 2019, with the analyses taking place from July 2021 to March 2022.
Researchers defined low-value care as “tests, treatments, and procedures that provide little to no clinical benefit,” and determined it through 26 “claims-based measures.” They also looked at whether the following factors mitigated the differences in low-value care between TM and MA recipients and among different groups of MA beneficiaries:
- Utilization management
- Value-based payment
- Network design
Researchers discovered that Medicare Advantage beneficiaries received just over nine percent fewer low-value services than those in traditional Medicare. More specifically, people enrolled in health management organization products had the lowest rates of low-value care. In terms of primary care payment arrangements, MA recipients again had the lowest rates of low-value care. In particular, MA beneficiaries whose primary physicians were reimbursed with two-sided risk arrangements had the lowest rates of low-value care out of all MA beneficiaries studied.
Though the research team admits their study has several limitations, including being based on a very specific set of low-value care measures that don’t account for all low-value care as well as only looking at those enrolled in one large national MA plan, they say it could provide important guidance for efforts to reduce low-value care, both in Medicare and private insurance programs.