People with higher medical needs were more likely to be in traditional Medicare non-accountable care organizations (ACOs) than in Medicare Advantage in 2019. The number of people enrolling in Medicare Advantage or Medicare ACOs grew from 2016 to 2019, according to a new report published Tuesday in The American Journal of Managed Care.
Investigators looked at insurance choices for people with high medical needs. Specifically, researchers examined Medicare Advantage or traditional Medicare ACOs compared to traditional Medicare and non-ACOs.
Investigators examined Medicare claims and Medicare Advantage data. The team broke up participants into three groups: People under 65 years with a disability or end-stage kidney disease; participants with frailty; and older people with major complex or multiple noncomplex chronic conditions. The team also included beneficiaries without high needs, which included people with minor complex chronic conditions. Data came from 50.9 million people in 2016 and 54.7 million people in 2019.
In 2019, 32% of people in traditional Medicare and Medicare Advantage had high needs — up from 1 million three years earlier. People with higher needs made up 38% of those enrolled in ACOs, 36% in non-ACOs and 24% in Medicare Advantage .
The amount of high-need beneficiaries in traditional Medicare was stable during the study period, but there was a 39% increase in high-need beneficiaries using ACOs while non-ACO use saw a 23% decrease during that time.
Medicare Advantage enrollees were more likely to be relatively healthy compared with those in traditional Medicare ACOs and non-ACOs, the data showed.
In 2019, approximately 2% of Medicare enrollees switched between traditional Medicare and Medicare Advantage. More than 50% of them who switched between both plans either way had high needs. Traditional non-ACOs stayed as the main source of coverage for those with high needs, the data showed.
Although the proportion of high-need beneficiaries in Medicare Advantage was smaller than traditional Medicare ACOs and non-ACOs, most of the high-needs Medicare Advantage users are mostly disabled and under 65 years old.
