Including Patients with ESRD in Medicare Advantage Plans
Summary
The 21st Century Cures Act allowed Medicare beneficiaries with end-stage renal disease (ESRD) to enroll in Medicare Advantage (MA), requiring MA plans to adapt to this clinically complex patient population with high care needs. The client, a large MA organization, sought our assistance to learn more about the characteristics and enrollment patterns of patients with ESRD enrolled in fee-for-service (FFS) Medicare in its market. The client used the recommendations resulting from our data analysis to adjust its strategy, tools, and benefits to accommodate this beneficiary population.Client Type
Large Medicare Advantage organization
Challenge
Until January 1, 2021, Medicare beneficiaries with ESRD (i.e., kidney failure) could enroll only in Medicare Parts A and B, with few exceptions. The 21st Century Cures Act removed this prohibition, enabling patients with ESRD to enroll in MA plans.
In 2019, more than 500,000 Medicare beneficiaries had ESRD according to the Centers for Medicare & Medicaid Services. This patient population suffers high comorbidity rates and faces barriers to treatment access and adherence, leading to higher-than-average costs for payers. As Medicare beneficiaries living with ESRD became newly eligible to enroll in MA plans, MA organizations wanted to better understand how to design plan benefit packages to meet the needs of enrollees with ESRD. With our help, the client gained the insights needed to adapt its future benefits and project future enrollment.
Solution
By accessing Medicare enrollment data, we identified Medicare beneficiaries with ESRD who were enrolled in FFS Medicare in late 2020 as well as those who were enrolled in an MA plan in 2021. These data revealed an active choice by some beneficiaries with ESRD to enroll in MA during the first open enrollment period when that option was available.
Focusing on beneficiaries with ESRD who enrolled in an MA plan in 2021, we segmented the population based on demographic and other attributes (e.g., age, race/ethnicity, gender, dual eligibility status) to determine which sub-populations chose to enroll in MA at the first opportunity.
We also identified the specific MA plans that enrolled patients living with ESRD, determined which parent organizations enrolled the highest numbers of these patients and identified what plan benefit designs may have influenced patient choices.
Outcome
With our assistance, the client gathered data and information on which patients with ESRD shifted from FFS to MA and which MA plans those patients selected. The client, by better understanding this patient population and comparing its own experiences to those of competing plans, adjusted its strategy as needed to establish bids, modify benefit design, and introduce care management tools to better serve these beneficiaries in the future.
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Robin Duddy-Tenbrunsel
Robin Duddy-Tenbrunsel provides policy analysis and strategic advice to stakeholders across the healthcare continuum, with focuses on Medicare Advantage and social determinants of health.
Emily M. Gillen
Emily Gillen provides clients with data-driven policy analytics and strategic insights.