Case Studies

From multi-year task orders with a team of subcontractors to smaller-scale individual research efforts, L&M has led dozens of research projects from government agencies, as well as private clients.


Centers for Medicare & Medicaid Services (CMS), September 2008 through January 2014

Objective

Assist CMS in understanding trends in benefits and cost-sharing arrangements in Medicare Advantage (MA) plans and how these impact beneficiaries, particularly those with chronic conditions.

Challenges

The team was tasked with analyzing and then summarizing hundreds of dimensions of MA plans in a meaningful way. This required both the technical expertise to build and work with a data set incorporating several years of data and multiple data sources, as well as the ability to highlight the most important findings and translate complex statistical analyses for a policy-making audience. Another challenge involved pricing out-of-pocket costs for individuals with chronic conditions when no claims data for these individuals were available. This group requires a sophisticated matching analysis, as well as a side analysis to test the validity of the approach.

Approach

L&M analyzed Health Plan Management System (HPMS) data for each MA plan to understand how premiums, cost sharing, and supplementary benefits had been changing over the period 2006 to 2010; how these changes impacted the average consumer; and how the impacts varied by geographic location and plan type. For the impact analysis, the team focused on variations in out-of-pocket costs for Medicare beneficiaries with chronic conditions under fee-for-service (FFS) compared to those enrolled in MA plans. The team created a matched sample of FFS and MA-enrolled beneficiaries and developed a complex algorithm using Medicare claims data to assess utilization patterns across FFS chronic condition cohorts. These utilization patterns were then mapped to the MA plan benefits structures to calculate out-of-pocket costs for MA-enrolled beneficiaries with different chronic conditions at different severity levels and identify drivers of higher out-of-pocket costs. A side analysis using Medicare Expenditure Panel Survey data, which includes utilization for individuals in FFS and MA, was conducted to validate the appropriateness of applying FFS utilization patterns to an MA population.


Results

Our Team:

  • Organized, analyzed, and deciphered a vast amount of data to provide a snapshot of changes in MA plans and how these changes impacted beneficiaries
  • Helped CMS better understand the out-of-pocket costs of beneficiaries with chronic conditions, elucidating the plan features that most impacted these costs for different conditions
  • Identified areas of focus to improve monitoring and oversight of MA plans

CMS has exercised the first three option years under this task order contract; the team is continuing longitudinal analyses of plan and benefit trends and MA-FFS cohort analyses through the 2013 contract year.