Medicare Advantage Plan and Health System Vertical Integration, 2011-2020

This cross-sectional study compares the beneficiary and plan characteristics and trends in enrollment, premiums, star ratings, and benefits of nonintegrated, non–legacy-integrated, and legacy-integrated Medicare Advantage plans between 2011 and 2020.


Introduction
3][4][5] Legacy-integrated MA plans may differ in ways that allow them to uniquely increase quality and premiums compared with newer integrated MA plans. 5e to limited data on integration status, there is a lack of evidence about the recent increase in integrated MA plans, their organizational characteristics, and the types of beneficiaries they enroll.
Using a novel MA integration dataset, we compared the beneficiary and plan characteristics and A, Enrollment in non-legacy-and legacy-integrated Medicare Advantage (MA) plans.B, Enrollment in non-legacy-integrated MA plans by race and ethnicity.C, Enrollment in legacyintegrated MA plans by race and ethnicity.Legacy-integrated MA plans are for beneficiaries in Kaiser Permanente, Intermountain Health, or Geisinger.Non-legacy-integrated MA plans are for beneficiaries in all other integrated MA plans.The vertical integration dataset and Medicare Beneficiary Summary File datasets were used to calculate enrollment.The vertical integration dataset and Medicare Beneficiary Summary File datasets were used to calculate enrollment.The RTI International race and ethnicity variable from the Medicare Beneficiary Summary File was used for stratification.
a Other includes any other race or ethnicity not included in the options.plans.We linked these data to the Medicare Beneficiary Summary File (MBSF) for beneficiary characteristics and publicly reported plan data for plan characteristics.We limited our analysis to beneficiaries who were in a MA plan in January of each year.We described the beneficiary (age, race and ethnicity [RTI International race code in MBSF], sex, dual beneficiary status) and plan characteristics (premium; star rating; maximum out of pocket; hierarchical condition category [HCC]   risk score; monthly capitated payments; and dental, hearing, and vision benefits) stratified by integration status, compared the growth of integrated MA plans over time, and assessed trends in premiums, star ratings, and benefits.Data were analyzed from August 2023 to May 2024 using Stata, version 18.We followed the STROBE reporting guideline, and this study was deemed exempt from informed consent by the Brown University institutional review board due to the use of deidentified data.

Discussion
Nearly 1 in 6 MA beneficiaries were enrolled in an integrated MA plan in 2020.Enrollment in legacyand non-legacy-integrated MA plans has been associated with an increase in beneficiaries from racial and ethnic minority groups.Legacy-integrated MA plans had higher star ratings but higher premiums compared with nonintegrated and non-legacy-integrated MA plans.[4]6 A limitations of this study is that it is descriptive, and causality cannot be assumed.This study suggests that only legacy-but not non-legacy-integrated MA plans offer beneficiaries higher star ratings for the higher premium compared with nonintegrated MA plans.

Figure .
Figure.Trends in Enrollment by Integration Status and Race and Ethnicity, 2011-2020

Table .
Beneficiary and Plan Characteristics of MA Beneficiaries Stratified by Plan Integration Status in 2020 a Percentages were calculated using 2020 data.b Other includes any other race or ethnicity not included in the options.JAMA Network Open | Health Policy JAMA Network Open.2024;7(7):e2423733.doi:10.1001/jamanetworkopen.2024.23733(Reprinted) July 19, 2024 2/4 Downloaded from jamanetwork.comby guest on 08/02/2024 was 19 976 932 in nonintegrated MA plans, 2 138 365 in non-legacy-integrated plans, and 1 646 677 in legacy-integrated MA plans.Trends in number of beneficiaries enrolled overall increased in both non-legacy-and legacy-integrated MA plans(Figure).Enrollment in non-legacy-integrated MA plans increased compared with legacy-integrated MA plans.The share of enrollment of beneficiaries from racial and ethnic minority groups increased compared with White beneficiaries in both non-legacy-and legacy-integrated MA plans (Table).Beneficiaries in legacy-integrated MA plans were older than those in nonintegrated and non-legacy-integrated MA plans (mean [SD] age,