IS THERE POSITIVE SPILLOVER ON QUALITY OF CARE FROM THE MEDICARE ADVANTAGE PROGRAM ON TRADITIONAL MEDICARE

Abstract

The amount the government should be spending for the Medicare Advantage program has been a long-standing debate. To answer this question, many studies seek to identify cost differences between TM (Traditional Medicare) and MA (Medicare Advantage) programs. Because of differences in the programs, direct cost comparisons are challenging and do not capture potential social benefits the MA program provides for TM enrollees. Social benefits would come from a positive spillover of efficiencies established in MA coverage areas. MA spillover lowering the cost of care in the TM program must be considered when performing budgetary comparisons. The purpose of this study is to examine the effect of post-ACA (Affordable Care Act) MA program growth on the quality of care for TM enrollees. As a result of the ACA, CMS (Center for Medicare & Medicaid Services) has been developing and implementing new models intended to reduce cost and improve the health of Medicare enrollees. Many of the studies that have examined an MA spillover effect were conducted with pre-ACA data. Using post-ACA data, this study focuses on six health outcome measures: 1) Potentially Avoidable Hospital Admission, 2) Inpatient Hospital Stays, 3) Inpatient Hospital Days, 4) Acute Hospital Readmission, 5) Emergency Department Visits, and 6) Outpatient Visits. These six health outcomes measures serve as a proxy for behavioral and other changes within TM enrollees that are influenced by MA plans.