ArticleHealth services research2018
Getting What We Pay For: How Do Risk-Based Payments to Medicare Advantage Plans Compare with Alternative Measures of Beneficiary Health Risk?
Article in Health services research, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
14 citing papers in PubMed.
- Transcatheter Aortic Valve Replacement (TAVR) in Medicare Advantage and Medicare Fee-for-Service: Differences in Patient Characteristics, Utilization, and Outcomes.Circulation. Population health and outcomes · 2026Article
- Advancing the measurement of favorable selection in Medicare Advantage: evidence from encounter data.Health affairs scholar · 2026Article
- Hospital Readmission Reduction Program Penalties for Hospitals With High Medicare Advantage Penetration.JAMA network open · 2026Article
- Identifying Coding Intensity in Medicare Advantage Through Switchers.Health services research · 2025Article
- Private Medicare plans' responses to benchmark changes and competition before and after the Affordable Care Act's payment cuts.Health services research · 2025Article
- Prevalence of Chronic Medical Conditions Among Medicare Advantage and Traditional Medicare Beneficiaries.Annals of internal medicine · 2025Article
- Coding intensity variation in Medicare Advantage.Health affairs scholar · 2025Article
- Trends in Cumulative Disenrollment in the Medicare Advantage Program, 2011-2020.JAMA health forum · 2023Article
- Differences In Use Of Services And Quality Of Care In Medicare Advantage And Traditional Medicare, 2010 And 2017.Health affairs (Project Hope) · 2023Article
- Observational
- The effects of coding intensity in Medicare Advantage on plan benefits and finances.Health services research · 2021Article
- Medicare Advantage Chart Reviews Are Associated With Billions in Additional Payments for Some Plans.Medical care · 2021Review
- Improving the Performance of Risk Adjustment Systems: Constrained Regressions, Reinsurance, and Variable Selection.American journal of health economics · 2021Article
- Likelihood of hospital readmission in Medicare Advantage and Fee-For-Service within same hospital.Health services research · 2020Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
2 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo estimate the relative health risk of Medicare Advantage (MA) beneficiaries compared to those in Traditional Medicare (TM). DATA SOURCES/STUDY
settingMedicare claims and enrollment records for the sample of beneficiaries enrolled in Part D between 2008 and 2015. STUDY
designWe assigned therapeutic classes to Medicare beneficiaries based on their prescription drug utilization. We then regressed nondrug health spending for TM beneficiaries in 2015 on demographic and therapeutic class identifiers for 2014 and used coefficients from this regression to predict relative risk of both MA and TM beneficiaries. PRINCIPAL
findingsBased on prescription drug utilization data, beneficiaries enrolled in MA in 2015 had 6.9 percent lower health risk than beneficiaries in TM, but differences based on coded diagnoses suggested MA beneficiaries were 6.2 percent higher risk. The relative health risk based on drug usage of MA beneficiaries compared to those in TM increased by 3.4 p.p. from 2008 to 2015, while the relative risk using diagnoses increased 9.8 p.p.
conclusionsOur results add to a growing body of evidence suggesting MA receives favorable, or, at worst, neutral selection. If MA beneficiaries are no healthier and no sicker than similar beneficiaries in TM, then payments to MA plans exceed what is warranted based on their health status.
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