Medicare Advantage For All? Not So Fast
Ken Terry & David Muhlestein (Health Affairs Blog 3/11/2021)
PAW Note: Overall much more positive review of MA than the title implies
In researching this paper, the biggest conundrum we encountered is the fact that per-enrollee MA cost growth exceeds the rate of per-beneficiary cost growth in traditional Medicare. Perhaps, this is related to how MA plans raise their risk scores: When primary care physicians diagnose additional conditions in MA members, they’re obligated to provide more services to manage those conditions, pushing up costs in the short run. With MA expanding rapidly, many new enrollees with chronic conditions are entering that funnel, so per-enrollee costs are rising; but in the long run, those costs should plateau or decline because of avoided medical crises. Newly available encounter data from CMS might clarify whether this is true or whether there is another explanation.
