Study: Rural patients struggle with access under Medicare Advantage

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Dissatisfaction with access to care is causing rural patients to move away from Medicare Advantage plans. (Getty/OgnjenO)

Rural patients are more than twice as likely as their non-rural counterparts to switch from Medicare Advantage to traditional Medicare coverage—and they do so predominantly due to dissatisfaction with access to care.

A new study in Health Affairs found that rural patients with the poorest health status were substantially more likely to switch from a Medicare Advantage plan to a traditional Medicare plan than other patients.

Adjusted switching levels reached 11.6% for that group, compared to 10.5% for rural patients overall and just 5% for non-rural patients.

More alarmingly, that switching takes place in only one direction, Sungchul Park, assistant professor in the Department of Health Management and Policy at Drexel University, told Fierce Healthcare. “The switching rates from traditional Medicare to Medicare Advantage among rural and non-rural enrollees was about 2%,” he said.

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To get an idea of why this switching might be happening, researchers examined satisfaction scores across a range of measures. “We found that people who were dissatisfied with access to care were more likely to switch from Medicare Advantage to traditional Medicare, and the rate was especially high for people who lived in rural areas,” Park said.

Medicare Advantage programs are designed to provide patients more flexibility than traditional Medicare. In his previous research, Park has found that Medicare Advantage providers may deliver care more efficiently than traditional Medicare providers do. However, the incentives that Medicare Advantage programs have to keep enrollees healthy and reduce care costs could potentially create a perverse incentive when it comes to high-cost, high-need patients.

Whether misaligned incentives are the problem here is unclear. Park said the available data simply isn’t robust enough to determine the mechanism that causes patients to be dissatisfied to care access, but he believes the flexibility Medicare Advantage programs have may be a key part of the problem.

“I think our findings suggest that this issue may be more pronounced in Medicare Advantage because they can determine which providers to include in their network or not,” he said.

The existence of a disparity in switching isn’t necessarily a problem in and of itself, as long as patients who switch receive care aligned with their needs. The link to dissatisfaction with access to care, combined with the tendency for more restrictive provider networks among Medicare Advantage plans suggest that the benefits of these plans may not be robust enough to keep patients from switching—and that rural enrollees have access to a smaller number of Medicare Advantage plans overall.

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The study recommends two areas in which policymakers could take steps to address the issue. First, since primary care physicians are less likely to practice in rural areas for a variety of reasons, creating financial incentives for healthcare workers could begin to address the overall shortage of rural medical practitioners. Second, it could be worth looking at incentives for Medicare Advantage plans to provide better access to these patients through mechanisms such as a payment add-on for plans that operate in rural areas.

“We found in the study that something is going on here: rural Medicare Advantage enrollees are facing limited access-to-care issues,” Park said. “But to provide more specific policy implications, I think we need better data and more information.”