Harvard-Inovalon Medicare Study

SUMMARY

• While Medicare Advantage (MA) now covers over half of Medicare beneficiaries, including a
  disproportionate share of those facing socioeconomic disadvantage and complex care needs, there is limited understanding of how quality of care under MA compares to Medicare Fee-for-Service (FFS). There is particularly limited understanding on how quality of care differs under MA and FFS for the most disadvantaged or complex populations.
• Harvard and Inovalon have partnered to shed light on this critical question, using Inovalon’s unique data assets and quality measurement analytics. Inovalon’s combined data track individuals’ pre-65 quality of care outcomes under commercial insurance coverage, as well as post-65 utilization under MA or FFS coverage. Looking at a recent five-year time period, 2015 through 2019, Inovalon’s data allowed us to quantify the incremental impact of MA vs. FFS on key quality outcomes, while accounting for any differences that were already pre-existing prior to Medicare enrollment.
• We find that MA delivers superior quality and health outcomes relative to FFS, especially after rigorously adjusting for enrollment differences across the two programs and for the pre-existing disadvantages faced by MA members in terms of baseline demographic, clinical, and social risk factors. These differences were outlined in detail in the first white paper in this series “Who Enrolls in Medicare Advantage vs. Traditional Medicare Fee-for-Service.”
• Specifically, MA enrollees have over 70% fewer hospital readmissions and 25% fewer preventable
  inpatient admissions. At the same time, we find that MA exhibits lower rates of inappropriate medication use, and comparable rates of medication adherence.
• This work is intended to support health plans and policymakers through valuable analytics and new
  insights. This research and development work gives Inovalon the foundational capabilities to benchmark a specific MA plan’s quality of care against its peers, and also evaluate quality of care among specific subpopulations such as the socioeconomically disadvantaged.
• Harvard and Inovalon’s analytic insights can pinpoint opportunities for quality improvement, especially among socioeconomically disadvantaged populations, and help health plans promote health equity. This work is timely given the newly announced Centers for Medicare & Medicaid Services (CMS) Health Equity Index framework, which will impact MA plan Five Star Ratings and bonus payments through the reward factor.

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