Medicare Advantage Plan Design, Utilization and Health Equity

BOWIE, Md. – April 8, 2024 – Inovalon, a leading provider of cloud-based software solutions empowering data-driven healthcare, today released new research in collaboration with Harvard Medical School analyzing how Medicare Advantage (MA) plans’ financial generosity and coverage design impact enrollment, socioeconomic-related health disparities, and utilization outcomes. Results show that zero-premium MA plans attract a substantially more socioeconomically disadvantaged population compared to non-zero premium MA plans and traditional Medicare Fee-for-Service (FFS), and Health Maintenance Organization (HMO) plans have significantly lower utilization than Preferred Provider Organization (PPO) and FFS plans.  

The findings, published in the white paper “The Importance of Plan Design in Medicare Advantage,” represent the fourth installment of Inovalon’s and Harvard Medical School’s research collaboration to understand the underlying factors influencing enrollment, quality outcomes, and utilization in MA vs. FFS Medicare. Previous research found that MA delivers superior quality outcomes and utilization reductions compared to FFS Medicare, even after controlling for differences in who enrolls. However, until now, there was limited data on the differences within MA, and how specific MA plan designs and features impact outcomes.  

Notable findings include:  

• Demographic and socioeconomic characteristics differ significantly for enrollees in zero-premium MA plans compared to higher-premium options:  
  • Enrollees in zero-premium plans are three times as likely to be non-white and are more likely to live in urban areas than other MA and FFS enrollees 
  • Zero-premium MA enrollees have a net worth of 90% of the net worth of other MA enrollees and only 70% of FFS enrollees 
  • Compared to those in other MA or FFS plans, zero-premium enrollees are more likely to have a high school education or less, less likely to own their own home or vehicle, less likely to be married, and more likely to have difficulty speaking English 

• Enrollees in MA HMO plans are more socioeconomically disadvantaged and experience lower healthcare utilization than MA PPO enrollees: 
  • MA HMO enrollees are three times more likely to be non-white than those in MA PPO plans 
  • Utilization under MA HMOs is 29% lower relative to a comparable population in MA PPOs, equating to $2,460 lower utilization per person annually 

“Our research challenges the misconception that Medicare Advantage is a monolith, revealing significant differences in plan designs and features and how those variables affect enrollment and outcomes,” said Boris Vabson, Ph.D., a health economist at Harvard Medical School and co-lead researcher on the project. “By understanding the populations Medicare Advantage plans attract, policymakers and health plans can come together to incentivize and deliver superior, cost-effective outcomes for every Medicare enrollee.” 

Limited data prevented previous studies from analyzing how different plan types and features, such as out-of-pocket costs and coverage design, impact enrollment decisions and outcomes. This study bridges the gap by leveraging the nation’s largest longitudinal primary source healthcare dataset, Inovalon’s MORE2 Registry^®, which covers 100% of public Medicare lives and 30% of all privately insured lives.  

“Our analysis can help Medicare Advantage and other health plans more effectively serve their member populations by offering tailored designs and features,” said Christie Teigland, Ph.D., Vice President of Research Science and Advanced Analytics at Inovalon and co-lead researcher on the project. “With these insights health plans can project expected enrollment, evaluate the performance of their features against industry benchmarks, and identify opportunities to address health disparities and deliver optimal outcomes.”   

To download the white paper and learn more about the research, please visit: www.inovalon.com/harvard-inovalon-medicare-research-collaboration/.