Medicare Advantage Ratings And Voluntary Disenrollment Among Patients With End-Stage Renal Disease

Abstract

Populations with intensive health care needs and high care costs may be attracted to insurance plans that have high quality ratings, but patients may be likely to disenroll from a plan if their care needs are not met. We assessed the association between publicly reported Medicare Advantage plan star ratings and voluntary disenrollment of incident dialysis patients in the following year over the period 2007-13. We found that Medicare Advantage (MA) plans with lower star ratings had significantly higher rates of disenrollment by incident dialysis patients in the following year. Compared to MA plans with 4.0 or more stars, adjusted disenrollment rates were 3.9 percentage points higher for plans with 3.5 stars, 5.0 percentage points higher for those with 3.0 stars, and 12.1 percentage points higher for those with 2.5 or fewer stars. These findings suggest that low plan quality may lead to increased expenditures, as this high-cost population generally must shift from Medicare Advantage to traditional Medicare upon disenrollment.

Keywords: Medicare Advantage plan star rating; end stage renal disease; voluntary disenrollment.

Exhibit 3. Adjusted disenrollment rates of incident end-stage renal disease patients, by Medicare Advantage (MA) star rating

SOURCE Authors’ analysis of information for 2007–13 from the five national databases listed in the notes to exhibit 1. NOTES Star ratings were for 2012. The error bars indicate 95 percent confidence intervals. Model adjusts for all covariates listed in exhibit 2, at the patient and area levels. The adjusted results were based on the binary logistic model, with four or more stars as the reference group. The marginal effects were estimated by the margins command (see note in text). Compared with MA plans with four or more stars, plans with fewer stars had significantly higher disenrollment rates (p < 0:001).