Medicare Advantage Value-Based Care Linked to Lower Mortality

Inovalon conducted an analysis using national Medicare Fee-for-Service (FFS) beneficiary data to evaluate mortality rates in 2020. The FFS mortality rates were compared to mortality rates in a large population of Medicare Advantage (MA) members enrolled with a value-based primary care provider. Cano Health is one of the nation’s leading independent providers of primary care services for seniors, serving MA members at its medical centers in Florida, Texas, Nevada, California, Illinois, and New Mexico.

Medicare FFS enrollment and claims data were obtained under a research data use agreement (DUA) with the Centers for Medicare and Medicaid Services (CMS) which provides access to 100% of Medicare FFS Parts A, B, and D claims data. Inovalon extracted a nationally representative 20% random sample to describe overall mortality among Medicare FFS beneficiaries aged 18 and older during the 2020 calendar year. Cano Health calculated the mortality rate for MA members enrolled in their medical centers using the measure specifications and methodology provided by Inovalon to assure comparable metrics.

The average age of Medicare FFS beneficiaries in 2020 was 72 years. The study population was 54% female, 85% White, 9% Black, 2% Hispanic/Latino, and 2% Asian. Slightly under one-fourth (23%) of FFS enrollees were entitled to Medicare due to disability and/or ESRD, while 77% received Medicare because they were age 65 or older. About one in five FFS enrollees (19%) were dually eligible for Medicare and Medicaid, which is often used as a proxy for low-income status. The most frequently observed chronic conditions in the FFS population were hypertension (69%), hyperlipidemia (61%), arthritis (44%), and diabetes (30%).

The average age of MA members enrolled at Cano Health medical centers in 2020 was 73 years. The Cano Health population was 58% female, 71% Hispanic/Latino, 19% White, 9% Black, and 1% Asian. Most members (90%) joined Medicare at age 65, and about half (48%) were dually eligible for Medicare and Medicaid. The most frequently observed chronic conditions were similar to the Medicare FFS sample: hypertension (76%), hyperlipidemia (70%), arthritis (44%), and diabetes (40%).

There were 50 deaths per 1,000 FFS beneficiaries in 2020, which translates to a 5% mortality rate during the year. Deaths rates were more than 2x higher among dual eligible beneficiaries, 8.9% vs. 4.2% among non-duals. Dual eligible members were younger (average age 65 vs. 74 for non-duals) but had a higher overall chronic condition burden as measured by the Charlson Comorbidity Index (CCI) score (mean CCI 5.0 vs. 4.0 among non-duals) and were more likely than non-duals to have diabetes (39% vs. 27%), depression (37% vs. 19%), and chronic kidney disease (36% vs. 28%).

Since Cano Health had a significantly higher proportion of dual eligible members, the FFS death rates were weighted to reflect the Cano Health non-dual/dual distribution to support a comparison of mortality rates. The adjusted FFS mortality rate was 6%, which was 2.5x higher than the 2.4% of Cano Health medical center MA members who died in 2020.