Medicare Advantage documents

Medicare Advantage plan beneficiaries with dementia report worse care experiences than enrollees with other chronic conditions, a new study finds. These patients are due more attention and support as the MA population continues to grow, the researchers say.

Investigators examined MA consumer service assessment surveys. Study participants had Alzheimer’s disease or related dementias (ADRD) and had used nursing home, home health or inpatient services within the last three years. When analyzed, the data showed that dementia patients were more likely to report lower scores for needed care and customer services when compared with MA recipients without ADRD.

Left out

Notably, beneficiaries with dementia were also twice as likely to be excluded from the performance measures surveys, either because they weren’t eligible or didn’t respond. This undercounting may result in MA plans not being held accountable for their outcomes, the researchers wrote. 

Among other standout findings, respondents who did not use proxies to complete their assessment forms reported worse outcomes than those whose proxies filled out the forms. However, non-proxy respondents with ADRD rated their MA plans more highly overall than their peers without dementia.

The investigators also looked at whether people with dementia who enrolled in MA special needs plans (SNPs) experienced improvements in care. SNPs are designed for patients with complex care needs, such as dementia. Despite rapid SNP enrollment growth, they found no significant care improvements for these enrollees.

Closing care gaps

There are a number of possible reasons for these care discrepancies, the researchers proposed. Based on prior research, MA beneficiaries tend to be admitted to lower-quality care settings than those in traditional Medicare, for example. Barriers to care such as prior authorizations and narrow networks may also contribute to additional burdens on these patients when compared to healthier enrollees. Finally, there is evidence that these enrollees face challenges in selecting the right plan, potentially leading to lower-rated care experiences, the researchers wrote.

Going forward, policy makers must design performance measures that more equitably include beneficiaries who have serious health conditions and functional and cognitive decline, and who require proxies to report on their care experiences, they added. 

“Otherwise, plans may not be properly incentivized to address these care experience gaps,” they concluded.

Full findings were published in the Journal of the American Geriatrics Society.

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