What Do We Know About Health Care Access and Quality in Medicare Advantage Versus the Traditional Medicare Program?

Care for Seniors in Medicare Advantage Versus the Veterans Health Administration

This set of studies differs less on their outcome measures than on their comparison groups. Six studies focus specifically on care in Medicare health plans versus the VHA system, an organized delivery system that in the 1990s – 2000s put special emphasis on measuring and improving quality of care (Appendix Table A.1).[endnote 133466-101] Of the six, two studies focus on HEDIS-type quality indicators, two studies focus on functional status, one study focused on mortality, and one study focused on the use of potentially appropriate drugs. Over the time period studied, almost all Medicare Advantage plans were HMOs. In all of the studies, the VHA system scored better after adjustments for health status. Though the studies as a whole are reasonably strong methodologically, they were limited by inconsistencies in the data available across the VHA and Medicare programs. Veterans also are a unique and diverse population and it is not clear how those veterans drawn to the VHA might differ from seniors served in Medicare Advantage. Because selection is always an issue in these studies, the studies could understate the VHA’s relative performance if Medicare covered veterans drawn to the VHA are sicker than those in Medicare Advantage. However, studies focused on the VHA, like those looking more generally at Medicare Advantage, lend support to the view that mature, organized health systems perform better on HEDIS-type measures, and the importance of recognizing variation in performance across the managed care sector.