Comprehensive Analysis of the Medicare Advantage Population

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The number of enrollees in Medicare Advantage (MA) plans has more than tripled in the past 12 years, with nearly one-third of all Medicare beneficiaries now enrolled in such plans. Because claims-level data have not been readily available, there is little published data on MA plan enrollees' demographics, use of health care, chronic conditions, quality outcomes, or expenses. With bipartisan support making it likely that MA will continue to expand, it is especially important that policymakers understand the composition of the MA population, including the subset of high-need, high-cost enrollees, to assess how well the program is meeting its members' needs. Using a representative population of MA beneficiaries extracted from Inovalon's proprietary Medical Outcomes Research for Effectiveness and Economics Registry for 2014-15, the Avalere Health team will undertake a comprehensive descriptive analysis of cross-sectional data on the MA population, including dual eligibles and other individuals with costly health needs. The researchers will then examine various MA population subgroups by applying the patient segmentation approach developed by Ashish Jha, M.D., and his team, with prior Commonwealth Fund support, to the MA beneficiary data. In consultation with the Fund, Avalere will establish an advisory council of independent experts to provide guidance on methods, data use, results, and products related to this study. By filling a longstanding gap in our knowledge of MA populations, including the high-need high-cost subset, this project will allow health plans, providers, and policymakers to determine which interventions will likely be most effective in improving the overall quality of care MA enrollees receive and lowering per beneficiary costs.

Grant Details

Grantee Organization:
Avalere Health, LLC
Principal Investigator:
Christie Teigland, Ph.D.
Award Amount:
$395,000.00
Approval Date:
April 11, 2017

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