Utilization, Spending Higher for Medicare Shared Savings Program vs Medicare Advantage Members
For Medicare Shared Savings Program (MSSP) and Medicare Advantage (MA) beneficiaries within the same health system, utilization and spending were higher for MSSP members even after adjusting for granular metrics of clinical risk, according to findings published in JAMA Network Open.
The retrospective economic evaluation included propensity score-matched beneficiaries continuously enrolled in MA or MSSP between January 1, 2014, and December 31, 2018, with hypertension, congestive heart failure (CHF), diabetes, or chronic kidney disease (CKD).
Of the 15,763 participants, 12,720 (81%) were enrolled in MA and 3043 (19%) were MSSP beneficiaries. When compared with MSSP beneficiaries, MA beneficiaries were more likely to be older (median [IQR] age, 75.0 [69.9-81.8] years vs 73.1 [68.3-79.8] years), male (5515 [43%] vs 1119 [37%]), White (9644 [76%] vs 2046 [69%]), and less likely to live in low-income zip codes (2338 [19%] vs 750 [25%]).
“The mean unadjusted per-member per-year spending difference between MSSP and MA disease-specific subcohorts was $2159 in diabetes, $4074 in CHF, $2560 in CKD, and $2330 in hypertension,” reported researchers. “After matching on clinical risk and demographic factors, MSSP spending was higher for patients with diabetes (mean per-member per-year spending difference in 2015: $2454; 95% CI, $1431-$3574), CHF ($3699; 95% CI, $1235-$6523), CKD ($2478; 95% CI, $1172-$3920), and hypertension ($2258; 95% CI, $1616-2,939).”
Study authors noted that over time higher MSSP spending among matched beneficiaries was consistent. MSSP total spending spanned from 23% (CHF) to 30% (CKD) higher than MA in 2018.
Spending differences between MSSP and MA were largely observed in higher outpatient hospital spending among MSSP beneficiaries, which resulted in 49% to 62% of differences in spending across disease cohorts, wrote researchers.
“Nonclinical factors likely contribute to the large differences in MA vs MSSP spending, which may create challenges for health systems participating in MSSP relative to their participation in MA,” concluded researchers.
Reference:
Parikh RB, Emanuel EJ, Brensinger CM, et al. Evaluation of spending differences between beneficiaries in Medicare Advantage and the Medicare Shared Savings Program. JAMA Netw Open. 2022;5(8):e2228529. doi: 10.1001/jamanetworkopen.2022.28529
