Assessing the Impact of Medicare Advantage on High-Cost, High-Need Beneficiaries and Exploring Interventions to Improve Outcomes


Although Medicare Advantage (MA) plans cover nearly one-third of Medicare beneficiaries, little is known about how well they serve high-need, high-cost (HNHC) beneficiaries. Gaining insight into the experiences of these enrollees is particularly important as private plans play a greater role in Medicare. More information is also needed about the track record of private insurers participating in MA, and the providers with whom they contract, in implementing promising care programs for HNHC beneficiaries. This study will offer a new, longitudinal perspective on the composition and experiences of the HNHC population in MA. It includes two complementary components: 1) a national assessment of trends among HNHC enrollees in MA plans, using data from the Health and Retirement Study from 2004 to 2016; and 2) an examination of how a large commercial payer, Blue Cross Blue Shield of Michigan, and its affiliated provider organizations have implemented a "high-intensity care" model to manage HNHC beneficiaries in MA. Data to be collected in the national assessment will include: type of plan (e.g., HMO, PPO, fee-for-service), length of enrollment, access to care, out-of-pocket costs, premiums, use of services, and health status. Based on its findings, the research team will explore potential interventions within the MA structure that could improve health outcomes for HNHC patients. Insights gleaned from this project will inform ongoing efforts to improve care for HNHC beneficiaries covered by MA plans. The research will also inform plan leaders looking to grow their MA programs. The target audience for this research comprises health insurers designing care management programs for HNHC beneficiaries, health system administrators, physician organizations, and policymakers.

Grant Details

Grantee Organization:
Regents of the University of Michigan
Principal Investigator:
Julia Adler-Milstein, Ph.D.
Award Amount:
Approval Date:
April 11, 2017

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