High-Cost Patients Had Substantial Rates Of Leaving Medicare Advantage And Joining--

[eridani]

--Traditional Medicare

http://content.healthaffairs.org/content/34/10/1675.abstract

We examined the relationship between use of hospital, nursing home, and home health care in 2010 and beneficiaries’ switching between Medicare Advantage and traditional Medicare by January 2011. Among traditional Medicare beneficiaries, we observed lower rates of switching into Medicare Advantage among people who used nursing home, home health, or acute inpatient care, compared with beneficiaries who did not use these services. In contrast, among Medicare Advantage beneficiaries, we found increased rates of switching into traditional Medicare among people who used nursing home and home health care, compared with beneficiaries who did not use these services.

Our results are consistent with other studies reporting that beneficiaries who report poorer health, use more health services, and have higher health care spending are more likely than their counterpart Medicare Advantage beneficiaries to leave Medicare Advantage plans, despite the recent reforms to the Medicare Advantage payment formula.

Comment by Don McCanne of PNHP: In 1997, The New England Journal of Medicine published a landmark article that showed that Medicare patients who enrolled in private Medicare HMOs exited them when they developed a need for a greater amount of health care: “The Medicare-HMO Revolving Door — The Healthy Go in and the Sick Go Out”

After nearly two decades of refinement of payment methods for the private Medicare Advantage plans, this new study from Health Affairs shows that “a high proportion of beneficiaries with nursing home or home health care use choose to exit the Medicare Advantage program.” Specifically, “Our results are consistent with other studies reporting that beneficiaries who report poorer health, use more health services, and have higher health care spending are more likely than their counterpart Medicare Advantage beneficiaries to leave Medicare Advantage plans, despite the recent reforms to the Medicare Advantage payment formula.”

The healthy go in and the sick go out. With Medicare Advantage plans, the patients and the taxpayers end up as losers.

[bemildred]

1. Cherry picking is what insurance companies do.

I will not accept an Advantage Plan, I want public health care, and that is traditional Medicare. The last thing I want to do is give insurance companies more money.

The error was not extending Medicare to everyone in the beginning.

[procon]

2. Why do patients leave?

Are they being forced out, or is the care worse or special needs unavailable?

[Recursion]

3. Medicare Advantage is private insurance

It's a damn scam, and we need to get rid of it.

[procon]

4. Not an answer to my question, but thanks anyway. nt

[eridani]

5. Special needs are unavailable. Regular Medicare has no "preferred provider" lists. n/t

[TheKentuckian]

6. I wonder what systematic savings could be had by ending Advantage