1. Comparing Quality in Medicare FFS and Medicare Advantage
Mark Shepard
Harvard University
Heritage Foundation Briefing
June 28, 2011

2. Context for MA-FFS Comparison
Mandate in MIPPA to compare quality in MA and FFS starting this year.
Quality comparisons are a potential tool for beneficiaries making enrollment choices.
Build on quality comparisons among plans when select MA plan on Medicare Plan Finder website.
Little previous work comparing the programs on quality of care because of data availability.
Goal: Compare MA and FFS nationally using identical measures, constructed as similarly as possible.

3. Data and Methods
MA: HEDIS data publicly reported for , pooled to form national quality rate
Exclude PFFS plans due to data availability
FFS: National measures for calculated from Medicare claims by CMS (GEM project)
Based on administrative HEDIS specifications
Statistically adjust for different geographic distribution of MA and FFS beneficiaries

4. Quality Measures
11 HEDIS measures of appropriate preventive screenings and medication management
Diabetes
HbA1c tests
Eye exams
LDL testing
Nephropathy screening/ med. attention
Heart Disease
LDL Testing
Beta Blockers After Heart Attack
Persistence on Beta Blockers for 6 months
Other
Breast Cancer Screening
Antidepressant Management
Anti-Rheumatic Drug Therapy
Monitoring for persistent meds.

5. Results: FFS vs. MA Quality, 2007

6. Results: FFS vs. MA Quality, 2007

7. Results: FFS vs. MA Quality, 2007

8. Results: FFS vs. MA Quality, 2007

9. Interpreting MA-FFS Differences
MA Higher Quality (8)
FFS Higher/Close (3)
All “well-established” in HEDIS: since 1990s
Declined in quality in MA from 2006 to 2007
All newer in HEDIS: introduced
Improved rapidly in MA from 2006 to 2007; also in
Suggested Explanation: MA “Learning Effect”

10. Older and Newer Measures in MA
Averages calculated from NCQA, State of Health Care Quality, 2010

11. Limitations of MA-FFS Comparison
Population Differences
Beneficiaries who choose MA may be easier/ harder to deliver appropriate care.
Measurement Differences
FFS has only claims data, while MA plans can also use chart review (hybrid measures).
Additional research needed to address these limitations.

12. Results: MA Distribution vs. FFS

13. Results: MA Distribution vs. FFS

14. Results: MA Distribution vs. FFS

15. Conclusions
MA better on 9 of 11 measures
Much better on 8 measures, slightly better or worse than FFS on 3 measures
MA performed best on older HEDIS measures, worst on the newer measures.
Suggested explanation: MA plan learning effect
Substantial differences in absolute terms, but even larger variation across MA plans