Analysis of medicare advantage HMOs compared with traditional medicare shows lower use of many services during 2003-09

Health Affairs

Volumn 31, Issue 12, 2012, Pages 2609-2617

  Landon, Bruce E ^a   Zaslavsky, Alan M ^a   Saunders, Robert C ^b   Gregory Pawlson, L ^c   Newhouse, Joseph P ^d   Ayanian, John Z ^a  

^a HARVARD MEDICAL SCHOOL   (United States)

^b NATIONAL COMMITTEE FOR QUALITY ASSURANCE   (United States)

^c Blue Cross Blue Shield Association   (United States)

^d HARVARD SCHOOL OF PUBLIC HEALTH   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

AGED; AMBULATORY SURGERY; ARTICLE; CORONARY ARTERY BYPASS SURGERY; EMERGENCY WARD; FEMALE; HEALTH CARE UTILIZATION; HEALTH MAINTENANCE ORGANIZATION; HIP ARTHROPLASTY; HOSPITALIZATION; HUMAN; KNEE ARTHROPLASTY; MALE; MEDICARE; COMPARATIVE STUDY; ECONOMICS; FACTUAL DATABASE; HEALTH CARE DELIVERY; HEALTH CARE SURVEY; MEDICAL FEE; OUTCOME ASSESSMENT; RETROSPECTIVE STUDY; STATISTICS AND NUMERICAL DATA; UNITED STATES; UTILIZATION; VERY ELDERLY;

AGED; AGED, 80 AND OVER; DATABASES, FACTUAL; FEE-FOR-SERVICE PLANS; FEMALE; HEALTH CARE SURVEYS; HEALTH MAINTENANCE ORGANIZATIONS; HEALTH SERVICES ACCESSIBILITY; HOSPITALIZATION; HUMANS; MALE; MEDICARE; MEDICARE PART C; OUTCOME ASSESSMENT (HEALTH CARE); RETROSPECTIVE STUDIES; UNITED STATES;

EID: 84871910512     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: 10.1377/hlthaff.2012.0179     Document Type: Article

References (27)

1. McGuire TG, Newhouse JP, Sinaiko AD. An economic history of Medicare Part C. Milbank Q. 2011; 89(2):289-332.
2. Medicare Payment Advisory Commission. Medicare Advantage program payment system. Washington (DC): MedPAC; 2010 Oct.
3. Medicare Payment Advisory Commission. Report to the Congress: Medicare payment policy [Internet]. Washington (DC): MedPAC; 2011 Mar [cited 2012 Oct 31]. Available from: http://medpac.gov/documents/Mar11_EntireReport.pdf
4. Gold M, Jacobson G, Damico A, Neuman T. Medicare Advantage 2012 data spotlight: enrollment market update [Internet]. Menlo Park (CA): Kaiser Family Foundation; 2012 [cited 2012 July 5]. Available from: http://www.kff.org/medicare/upload/8323.pdf
5. Landon BE, Wilson IB, Cleary PD. A conceptual model of the effects of health care organizations on the quality of medical care. JAMA. 1998;279(17):1377-82.
6. National Committee for Quality Assurance. HEDIS and quality measurement [Internet]. Washington (DC): NCQA; [cited 2012 Oct 31]. Available from: http://www.ncqa.org/tabid/59/default.aspx
7. Schneider EC, Zaslavsky AM, Epstein AM. Use of high-cost operative procedures by Medicare beneficiaries enrolled in for-profit and not-for-profit health plans. N Engl J Med. 2004;350(2):143-50.
8. To access the Appendix, click on the Appendix link in the box to the right of the article online
9. Yun H, Kilgore ML, Curtis JR, Delzell E, Gary LC, Saag KG, et al. Identifying types of nursing facility stays using Medicare claims data: an algorithm and validation. Health Serv Outcomes Res Methodol. 2010; 10(1):100-10.
10. Kaiser Family Foundation. Medicare: Medicare Advantage [Internet]. Menlo Park (CA): KFF; 2010 Sep [cited 2012 Oct 31]. (Fact Sheet). Available from: http://www.kff.org/medicare/upload/2052-14.pdf
11. Song Y, Skinner J, Bynum J, Sutherland J, Wennberg JE, Fisher ES. Regional variations in diagnostic practices. N Engl J Med. 2010; 363(1):45-53.
12. Dartmouth Institute for Health Policy and Clinical Practice. Dartmouth atlas of health care: understanding of the efficiency and effectiveness of the health care system [Internet]. Lebanon (NH): The Institute; [cited 2012 Oct 31]. Available from: http://www.dartmouthatlas.org/
13. Chernew ME, Sabik L, Chandra A, Newhouse JP. Ensuring the fiscal sustainability of health care reform. N Engl J Med. 2010;362(1):1-3.
14. Landon BE, Zaslavsky AM, Bernard SL, Cioffi MJ, Cleary PD. Comparison of performance of traditional Medicare vs Medicare managed care. JAMA. 2004;291(14): 1744-52.
15. Chan PS, Patel MR, Klein LW, Krone RJ, Dehmer GJ, Kennedy K, et al. Appropriateness of percutaneous coronary intervention. JAMA. 2011;306(1):53-61.
16. Patel MR, Dehmer GJ, Hirshfeld JW, Smith PK, Spertus JA. American College of Cardiology Foundation Appropriateness Criteria Task Force, et al. ACCF/SCAI/STS/AATS/AHA/ ASNC 2009 appropriateness criteria for coronary revascularization: a report by the American College of Cardiology Foundation Appropriateness Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, and the American Society of Nuclear Cardiology Endorsed by the American Society of Echocardiography, the Heart Failure Society of America, and the Society of Cardiovascular Computed Tomography. J Am Coll Cardiol. 2009;53(6):530-53.
17. Krieger N. Overcoming the absence of socioeconomic data in medical records: validation and application of a census-based methodology. Am J Public Health. 1992;82(5):703-10.
18. Fremont AM, Bierman A,Wickstrom SL, Bird CE, Shah M, Escarce JJ, et al. Use of geocoding in managed care settings to identify quality disparities. Health Aff (Millwood). 2005;24(2):516-26.
19. Krieger N, Chen JT, Waterman PD, Rehkopf DH, Subramanian SV. Painting a truer picture of US socioeconomic and racial/ethnic health inequalities: the Public Health Disparities Geocoding Project. Am J Public Health. 2005;95(2):312-23.
20. Krieger N, Chen JT, Waterman PD, Soobader MJ, Subramanian SV, Carson R. Geocoding and monitoring of US socioeconomic inequalities in mortality and cancer incidence: does the choice of area-based measure and geographic level matter? The Public Health Disparities Geocoding Project. Am J Epidemiol. 2002;156(5):471-82.
21. DeSalvo K, Jones T, Peabody J, McDonald J, Fihn S, Fan V, et al. Health care expenditure prediction with a single item, self-rated health measures. Med Care. 2009;47(4): 440-7.
22. Zaslavsky AM, Buntin MJB. Usingsurvey measures to assess risk selection among Medicare managed care plans. Inquiry. 2002;39(2): 138-51.
23. Zarabozo C, Harrison S. Payment policy and the growth of Medicare Advantage. Health Aff (Millwood). 2009;28(1):w55-67. DOI: 1377/hlthaff.28.1.w55.
24. Biles B, Arnold G, Guterman S. Medicare Advantage in the era of health reform: progress in leveling the playing field [Internet]. New York (NY): Commonwealth Fund; 2011 Mar [cited 2012 Nov 1]. (Issue Brief). Available from: http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2011/Mar/1491_Biles_Medicare_Advantage_era_hlt_reform_ib.pdf
25. Ginsburg PB. Wide variation in hospital and physician payment rates evidence of provider market power [Internet]. Washington (DC): Center for Studying Health Center Change; 2010 Nov [cited 2012 Nov 1]. (Research Brief No. 16). Available from: http://www.hschange.com/CONTENT/1162/1162.pdf
26. Medicare Payment Advisory Commission. Report to the Congress: Medicare payment policy [Internet]. Washington (DC): MedPAC; 2010 Mar [cited 2012 Nov 1]. Available from: http://medpac.gov/documents/Mar10_EntireReport.pdf
27. Landon BE. Keeping score under a global payment system. N Engl J Med. 2012;366(5):393-5.