Collaborative Research Provides Actionable Insights for Payers and Policymakers on Optimizing Plans to Best Meet the Needs of the Rapidly Growing Medicare Population
BOWIE, Md. – July 6, 2023 – Inovalon, a leading provider of cloud-based software solutions empowering data-driven healthcare, today announced that a first-of-its-kind study conducted by Inovalon and Harvard Medical School researchers uncovers stark differences in the characteristics of individuals who choose Medicare Advantage (MA) over traditional Medicare, at 65. The study looks at a remarkably detailed set of characteristics of MA vs Fee-for-Service (FFS) enrollees, including around economic status, race, income, and health. This research provides policymakers, health plans, and healthcare administrators with insights to help design value-based care programs, improve health outcomes, and address health inequities.
The findings, presented in an inaugural white paper Who Enrolls in Medicare Advantage vs. Medicare Fee-for-Service, are the first in a series to be released from a research collaboration between Inovalonand researchers at the Department of Health Care Policy at Harvard Medical School. The study aims to uncover and analyze underlying factors influencing enrollment in MA or FFS Medicare based on a comparison made at a critical point in a beneficiary’s journey: as beneficiaries are transitioning from commercial to Medicare coverage, at 65. The study is made possible through Inovalon’s unique primary source, longitudinally matched dataset, which allows researchers to track a given individual’s health and utilization both before and after Medicare enrollment, across both commercial and Medicare coverage. Inovalon’s data also includes highly detailed, ZIP9-level socioeconomic data, drawn from different sources. This contrasts with previous research that was limited to just Medicare data, and just to comparing the MA and FFS groups after Medicare enrollment.
While MA had initially attracted only a small share of eligible beneficiaries, enrollment has grown dramatically from 17% in 2000 to 48% in 2022. The increasing bifurcation of Medicare across these two coverage types makes it increasingly important for relevant stakeholders—policymakers, health plans, and patients—to understand how the programs are different.
Notable findings specific to enrollment include:
- MA enrollees are twice as likely to be non-white, and much more likely to be Black, Hispanic, or Asian.
- MA enrollees are over 50% more likely than those in traditional Medicare to have been enrolled in an HMO plan, immediately before turning 65.
- Substantial differences in health-relevant socioeconomic characteristics of MA and traditional Medicare enrollees. The average income of a traditional Medicare enrollee is $85,085, compared to $76,720 for an MA enrollee. This gap arises from the relative lack of MA enrollees in the most affluent segments. While 35.5% of traditional Medicare enrollees live in a neighborhood with incomes above $100,000, this is true for only 23.8% of MA enrollees. The average MA enrollee has a net worth that is 74.2% of the average traditional Medicare enrollee.
“The early findings from this first-of-its-kind research give an important view into the pre-65 demographic, clinical, and social risk characteristics of the rapidly growing Medicare population,” said Michael Chernew, PhD, health economist and professor at Harvard Medical School, who is helping oversee the project. “The findings provide new resources for policymakers and healthcare administrators to improve the delivery of value-based care programs, address health inequities, and improve health outcomes for all beneficiaries.”
“Historically, it has been challenging to document differences in beneficiaries who enroll in Medicare Advantage versus traditional Medicare at age 65,” said Christie Teigland, PhD, Vice President of Research Science and Advanced Analytics at Inovalon. “Our study provides a better understanding of the core customer segments of Medicare Advantage and which beneficiaries are most likely to enroll in which coverage type. This information can help health plans better tailor and target their products to enhance member recruitment and retention and better plan for future resource needs.”
The research utilized Inovalon’s MORE2 Registry®, the nation’s largest healthcare dataset originating from longitudinally matched, primary source data across 25 years of curation encompassing more than 76 billion medical events, social determinants of health (SDOH), clinical, and administrative data on nearly 370 million unique patients across commercial, Medicare, and Medicaid insurance, including 100% of the U.S. Medicare FFS program data accessed through a Centers for Medicare and Medicaid Services Data Use Agreement. Highly relevant to the study, Inovalon’s incorporated SDOH data included such data as median household income, education level, race and ethnicity, living alone, English proficiency, and other social risk factors.
To learn more about the research, download the first whitepaper, “Who Enrolls in Medicare Advantage vs. Traditional Medicare Fee-for-Service,” here.
Inovalon is a leading provider of cloud-based software solutions empowering data-driven healthcare. The Inovalon ONE® Platform brings together national-scale connectivity, real-time primary source data access, and advanced analytics into a sophisticated cloud-based platform empowering improved outcomes and economics across the healthcare ecosystem. The company’s analytics and capabilities are used by more than 20,000 customers and are informed by the primary source data of more than 78 billion medical events across one million physicians, 640,000 clinical settings, and 372 million unique patients. For more information, visit www.inovalon.com.