Medicare+Choice: Payment and Service Areas. Final Report. Tables and Figure

05/01/2005

Table 1: Key Measures and Their Source

Measure Source
Medicare+Choice participation HCFA(now known as CMS); match between HCFA(now known as CMS) and InterStudy 9.1
Plan model type (IPA, staff, group, mixed, etc.) InterStudy 9.1
Plan tax status (not-for-profit, for profit) InterStudy 9.1
Federally qualified InterStudy 9.1
Plan reports Medicaid enrollees InterStudy 9.1
Plan reports FEHBP enrollees InterStudy 9.1
National chain InterStudy 9.1
Total plan enrollment InterStudy 9.1
Plan age (yrs.) InterStudy 9.1
Enrollees per MD InterStudy 9.1
Enrollees per hospital InterStudy 9.1
Plan changes since 1995: 
Split into two or more plans
Smaller service area
Larger service area
InterStudy 9.1; InterStudy 5.2
High enrollment growth between 1996 and 1998 InterStudy 9.1
Decline in enrollment between 1996 and 1998 InterStudy 9.1
Percent enrollees in traditional HMO products InterStudy 9.1
Number commercial HMOs in county InterStudy 9.1
County demographic risk index HCFA(now known as CMS)
County in an MSA? ARF
County price-adjusted M+C rate HCFA(now known as CMS)
Percent county population over 65 ARF
County admission rate per ARF
County beds per ARF
County MDs per ARF
Price-adjusted median income ARF; HCFA(now known as CMS)
Unemployment rate 1996 ARF
Number Medicare plans 1998 HCFA(now known as CMS)
Change in payment rate HCFA(now known as CMS)
Medicare enrollment rate 1998 HCFA(now known as CMS)

Table 2: County-level Mean Medicare Beneficiaries and Managed Care Enrollees, by Change in Risk Plans Available 9/98-4/99

County Type Number Counties Medicare Beneficiaries, 12/98 Medicare Risk Enrollees, 12/98
County Mean Total Number Beneficiaries Percent All Beneficiaries County Mean Total Number Enrollees Percent All Enrollees
No plans, no change 2076 4768 9,899,045 25.64 2 4,486 0.08
Gained all plans 16 12101 193,609 0.50 3 52 0.00
No change 559 17623 9,851,375 25.52 2388 1,334,796 22.66
Lost all plans 84 9093 763,852 1.98 20 1,687 0.03
Net gain 35 21614 756,498 1.96 2286 80,018 1.36
Net loss 271 56292 15,255,112 39.51 14009 3,796,545 64.45
Balanced change 32 58979 18,87,318 4.89 21039 673,250 11.43
ALL COUNTIES 3073 12563 38,606,809 100.00 1917 5,890,834 100.00

Source: Analysis of Health Care Financing Administration(now known as Centers for Medicare and Medicaid Services(CMS)) data.


Table 3: County-Level Mean Number of Risk Plans and Payment Rates by Change in Risk Plans Available 9/98-4/99

County Type Number Counties Mean Number Risk Plans in County, 9/98 Mean Number Risk Plans in County, 4/99 Mean County Medicare Payment Rate, 1998 Mean County Medicare Payment Rate, 1999
No plans, no change 2076 0 0 401.10 411.67
Gained all plans 16 0 1 385.42 395.53
No change 559 2 2 435.94 445.70
Lost all plans 84 1 0 405.41 415.16
Net gain 35 2 3 436.21 445.80
Net loss 271 5 4 488.89 498.86
Balanced change 32 5 5 525.81 537.02
ALL COUNTIES 3073 1 1 416.92 427.26

Source: Analysis of Health Care Financing Administration(now known as Centers for Medicare and Medicaid Services(CMS)) data.


Table 4: County-Level Mean Unemployment, Wage Index, and Demographic Index by Change in Risk Plans Available 9/98-4/99

County Type Number Counties Mean County Unemployment Rate, 1996 Mean County HCFA(now known as CMS) Wage Index, 1997 Mean County Demographic Index, Medicare Beneficiaries, 1995
No plans, no change 2076 6.07 0.78 1.01
Gained all plans 16 6.69 0.84 1.04
No change 559 6.01 0.87 1.04
Lost all plans 84 5.96 0.87 1.04
Net gain 35 5.45 0.89 1.06
Net loss 271 5.51 1.01 1.05
Balanced change 32 6.26 0.94 1.06
ALL COUNTIES 3073 6.00 0.82 1.02

Source: Analysis of Health Care Financing Administration(now known as Centers for Medicare and Medicaid Services(CMS)) and Area Resource File data.


Table 5: Characteristics of Plans that Participated in Medicare+Choice in 1998 and Those that Dropped Out in 1999

  All commercial plans 1998 Was in M+C 1998 Was in M+C 1998, Dropped in 1999
IPA model 49% 50 66
Not for profit 27% 25 17
Federally qualified 37% 57 57
Has Medicaid pts 38% 40 46
Has FEHBP pts 34% 49 43
National chain 59% 73 83
Total enrollment (log) 10.70 11.73 11.58
Plan age 11.38 yrs 14.37 12.96
Total enrollees per MD 40 50 25
Total enrollees per hospital 3312 4977 2338
Plan changes since 1995:
   Split 4% 6 0
   Smaller service area 9% 10 14
   Larger service area 42% 52 57
High total enroll growth 11% 14 17
Decline in total enrollment 20% 20 17
Percent total enrollment in traditional HMO model 12% 14 13
N 647 248 35

Source: Analysis of data from InterStudy Competitive Edge 9.1 and the Health Care Financing Administration(now known as Centers for Medicare and Medicaid Services(CMS))

Note: Only those Medicare+Choice plans that could be matched with an InterStudy plan are included in this analysis. Plan characteristics are taken from InterStudy.


Table 6: Regression Estimates - 1998 Plan Participation and 1999 Dropouts

  Was in M+C 1998 Dropped M+C in 1999
Coefficient estimate p-value Coefficient estimate p-value
Intercept -1.35 0.0001 0.21 0.4712
IPA model 0.02 0.6068 0.09 0.0660
Not for profit -0.05 0.2854 0.02 0.8126
Federally qualified 0.10 0.0115 0.03 0.5155
Has Medicaid pts -0.09 0.0152 0.09 0.0862
Has FEHBP pts 0.05 0.1875 -0.06 0.2637
National chain 0.06 0.1485 0.13 0.0387
Total enrollment (log) 0.16 0.0001 -0.02 0.0535
Plan age (yrs.) 0.005 0.1039 -0.001 0.8875
Total enrollees per MD -0.001 0.0003 -0.0005 0.4340
Total enrollees per hospital 0.000 0.0780 -0.000 0.6445
Plan changes since 1995:
Split 0.10 0.2856 -0.15 0.1766
Smaller service area 0.07 0.2907 0.07 0.3757
Larger service area -0.04 0.3588 0.01 0.8258
High total enrollment growth 0.02 0.6973 0.02 0.8159
Decline in total enrollment -0.06 0.1750 0.01 0.9105
Percent total enrollment in traditional HMO model -0.00 0.4685 -0.01 0.2490
Dependent variable mean 0.39 0.14
N 605 235
R2 0.3112 0.0202

Source: Analysis of data from InterStudy Competitive Edge 9.1 and the Health Care Financing Administration(now known as Centers for Medicare and Medicaid Services(CMS))

Note: Only those Medicare+Choice plans that could be matched with an InterStudy plan are included in this analysis. Plan characteristics are taken from InterStudy.


Table 7: Characteristics of Counties with Medicare+Plans in 1998 and that Lost Plans in 1999

  Mean, All Counties Counties with M+C Plans, 1998 Counties that Lost M+C Plans, 1999
Number commercial HMOs 5.3 10.23 11.9
Demographic risk index 1.02 1.05 1.05
In an MSA 27% 76 83
Price-adjusted M+C rate $512 496 498
Pop share > 65 17% 14 13
Admission rate per pop 87 101 101
Beds per population 4.2 3.5 3.4
MDs per population 1.1 1.8 1.9
Price-adjusted median income $22040 22729 22970
Unemployment rate 1996 6.0% 5.5 5.5
Number Mcare plans 9/98 0.9 4.2 5.5
Change in payment rate 2.5% 2.1 2.1
Mcare enrollment rate 98 3% 14 17
N 3073 585 308

Source: Analysis of data from InterStudy Competitive Edge 9.1 and the Health Care Financing Administration(now known as Centers for Medicare and Medicaid Services(CMS))

Note: Only those Medicare+Choice plans that could be matched with an InterStudy plan are included in this analysis.


Table 8: Regression Estimates - Presence of M+C Plan in County in 1998 and Loss of Plan in 1999

  County has M+C plan(s) 1998 County loses plan 1999
Parameter estimate p-value Parameter estimate p-value
Intercept -1.07 0.0001 1.09 0.0374
Number commercial HMOs 0.05 0.0001 0.02 0.0097
Demographic risk index 0.69 0.0001 -0.88 0.0597
In an MSA 0.24 0.0001 -0.02 0.7669
Price-adjusted M+C rate 0.0003 0.0001 -0.0001 0.5497
Pop share > 65 0.36 0.0051 -0.76 0.0949
Admission rate per pop -0.0003 0.0016 -0.0001 0.8087
Beds per population 0.001 0.3358 0.002 0.8020
MDs per population 0.04 0.0001 -0.02 0.3709
Price-adjusted median income -0.000 0.8451 0.000 0.2999
Unemployment rate 1996 0.005 0.0081 0.01 0.0906
Number Mcare plans 9/98     0.08 0.0001
Change in payment rate     -0.07 0.1144
Mcare enrollment rate 98     0.26 0.1835
Mean of dependent variable 0.19 0.53
N 3072 584
R2 0.4478 0.2757

Source: Analysis of data from InterStudy Competitive Edge 9.1 and the Health Care Financing Administration(now known as Centers for Medicare and Medicaid Services(CMS))

Note: Only those Medicare+Choice plans that could be matched with an InterStudy plan are included in this analysis.


Table 9: Characteristics of Plan-County Pairs, for All, 1998 Participants, and 1999 Dropouts

  Mean, All Plan-County Pairs 1998 M+C 1999 Dropouts
Plan characteristics:
IPA model 52% 49 48
Not for profit 22% 20 11
Federally qualified 39% 59 49
Has Medicaid pts 38% 42 50
Has FEHBP pts 36% 51 35
National chain 64% 74 87
Total enrollment (log) 11.1 12.0 11.9
Plan age (yrs.) 11.7 years 14.6 12.7
Total enrollees per MD 41 51 26
Total enrollees per hospital 2822 5282 2828
Plan changes since 1995:
    Split 5% 3 4
    Smaller service area 6% 13 18
    Larger service area 54% 55 48
High total enrollment growth 13% 15 21
Decline in total enrollment 22% 22 25
Percent total enrollment in traditional HMO model 14% 13 15
County characteristics: 
Number commercial HMOs 8.1 11.2 11.8
Demographic risk index 1.03 1.05 1.05
In an MSA 45% 80 77
Price-adjusted M+C rate $505 506 492
Pop share > 65 15% 14 13
Admission rate per pop 90.5 104.4 97.1
Beds per population 3.7 3.6 3.6
MDs per population 1.3 2.0 2.0
Price-adjusted median income $22284 23153 23189
Unemployment rate 1996 5.78% 5.48 5.69
Number Mcare plans 9/98 2.0 5.2 5.5
Change in payment rate 2.4% 2.1 2.1
Mcare enrollment rate 98 6% 16 15
N 16340 2041 415

Source: Analysis of data from InterStudy Competitive Edge 9.1 and the Health Care Financing Administration(now known as Centers for Medicare and Medicaid Services(CMS))

Note: Only those Medicare+Choice plans that could be matched with an InterStudy plan are included in this analysis. Plan characteristics are taken from InterStudy.


Table 10: Regression Estimates - Plan-County 1998 Inclusion in M+C and 1999 Drop Outs

  Plan-county in M+C 1998 Plan-county dropped in 1999
  Coeff est p-value Coeff est p-value
Intercept -0.91 0.0001 0.52 0.0836
Plan characteristics:
IPA model -0.03 0.0001 -0.01 0.4490
Not for profit -0.01 0.0806 0.03 0.3302
Federally qualified 0.05 0.0001 0.009 0.6519
Has Medicaid pts 0.002 0.7672 0.08 0.0002
Has FEHBP pts 0.04 0.0001 -0.14 0.0001
National chain 0.01 0.1466 0.22 0.0001
Total enrollment (log) 0.03 0.0001 0.01 0.1951
Plan age (yrs.) 0.001 0.1037 -0.003 0.0226
Total enrollees per MD -0.0004 0.0001 -0.001 0.0001
Total enrollees per hospital 0.000 0.0001 -0.000 0.5427
Plan changes since 1995:
    Split 0.04 0.0874 -0.04 0.4327
    Smaller service area 0.08 0.0001 0.11 0.0006
    Larger service area -0.04 0.0001 -0.05 0.0171
    High total enrollment growth 0.02 0.0117 0.07 0.0124
Decline in total enrollment 0.02 0.0006 0.09 0.0002
Percent total enrollment in traditional HMO model -0.000 0.1491 -0.001 0.0382
County characteristics:
Number commercial HMOs 0.01 0.0001 0.005 0.1324
Demographic risk index 0.18 0.0031 -0.25 0.2938
In an MSA 0.11 0.0001 -0.08 0.0044
Price-adjusted M+C rate 0.0005 0.0001 -0.0004 0.0013
Pop share > 65 0.19 0.0040 -1.21 0.0001
Admission rate per pop -0.0002 0.0001 -0.0002 0.3705
Beds per population 0.001 0.4216 0.003 0.5387
MDs per population 0.02 0.0001 -0.002 0.8052
Price-adjusted median income 0.000 0.6372 0.000 0.4238
Unemployment rate 1996 0.003 0.0019 0.02 0.0001
Number Mcare plans 9/98     -0.001 0.0700
Change in payment rate     0.01 0.7249
Mcare enrollment rate 98     0.15 0.0973
Mean of dependent variable 0.13 0.21
N 14602 1913
R2 0.1740 0.1479

Source: Analysis of data from InterStudy Competitive Edge 9.1 and the Health Care Financing Administration(now known as Centers for Medicare and Medicaid Services(CMS))

Note: Only those Medicare+Choice plans that could be matched with an InterStudy plan are included in this analysis. Plan characteristics are taken from InterStudy.


Table 11: Medicare+Choice Payment Rates and Enrollment by MSA

  All MSAs Had Medicare+Choice Plan September 1998
Number 365 240
Mean number counties 8.4 8.9
Mean Medicare eligibles 1998 105,788 162,323
Mean M+C enrollees 1998 16,141 24,539
Mean M+C payment rate 1997:
    County $425 $446
    Eligibles $467 $481
    Enrollees $517 $518
Mean number commercial plans 9.92 11.80
Mean number M+C plans   4.13
Mean number areas per plan   3.20
Mean median plan share within area, excluding plans in 1 area   35%

Source: Analysis of data from InterStudy Competitive Edge 9.1 and the Health Care Financing Administration(now known as Centers for Medicare and Medicaid Services(CMS)).