Quality Advantage? Provider Quality and Networks in Medicare Advantage

Authors

  • Simon F. Haeder The Pennsylvania State University

DOI:

https://doi.org/10.20899/jpna.6.2.138-158

Keywords:

Medicare, Provider Networks, Healthcare Access, Provider Quality

Abstract

Medicare Advantage plans have grown significantly over the past decade and the potential for their future growth seems unabated. Astonishingly, however, we know little about how Medicare beneficiaries access services, particularly whether those services are of high quality. This study explores access to cardiac surgeons for coronary artery bypass grafting (CABG) and heart valve surgery in California and New York. It is one of the first studies to analyze Medicare Advantage networks and interactions between provider networks and provider quality. Results of the study show that for large metropolitan areas, access is rather similar for traditional Medicare and Medicare Advantage beneficiaries. Limitations, however, exist for the latter. Important concerns emerge for Medicare Advantage beneficiaries outside of metropolitan areas where healthcare market challenges appear to be exacerbated by carrier restrictions. Results indicate no evidence that carriers selectively contract to improve quality. There is, however, significant diversity with regard to network breadth; and, this breadth does not stay static across distances. These results hold important implications for the future of the Medicare program, network adequacy regulations, and how consumers make choices about their insurance coverage.

 

Author Biography

Simon F. Haeder, The Pennsylvania State University

Simon F. Haeder is an Assistant Professor of Public Policy in the School of Public Policy at The Pennsylvania State University. He is also a Fellow in the Interdisciplinary Research Leaders Program, a national leadership development program supported by the Robert Wood Johnson Foundation to equip teams of researchers and community partners in applying research to solve real community problems. He was part of the inaugural cohort of the American Enterprise Institute’s Emerging Poverty Scholars program.

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Published

2020-08-01

Issue

Section

Research Articles