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Monday, August 29, 2022

Costlier Medicare Advantage plans do not always offer better quality

Better metrics needed to help consumers make quality-focused choices

RAND CORPORATION

Enrolling in a highercost Medicare Advantage plan may not always get seniors better quality health care, according to a new RAND Corporation study.

Examining 15 different measures of quality among large representative samples of people enrolled in Medicare Advantage plans during 2016 and 2017, researchers found that plans that charged a higher monthly premium provided on average only slightly better care as compared to plans with no monthly premium.

Quality varied substantially within each premium cost tier studied, with high-quality care being observed among a number of plans in each of the cost tiers. More than 700 Medicare Advantage plans were part of the analysis.

The findings are published in the latest edition of JAMA Health Forum.

“Paying higher premiums is not necessary to receive high quality care from a Medicare Advantage plan,” said study lead author Amelia M. Haviland, a professor of statistics and public policy at Carnegie Mellon University and an adjunct statistician at RAND, a nonprofit research organization. “Seniors should look at metrics other than premium costs alone when looking for a Medicare Advantage plan that offers a high-quality of care, including direct measures of quality, such as Star Ratings.”

Health care costs are a concern for both consumers and policymakers. People enrolled in Medicare Advantage plans report that price measures such as premium costs and co-pays are their primary consideration when selecting a plan.

To examine the link between premium cost and quality, RAND researchers analyzed information about the care delivered to people enrolled in Medicare Advantage plans. About 40% of the enrollees were in plans with no monthly premium, while 6% were in plans with a monthly premium of more than $120.

Medicare Advantage plans provide coverage for hospital and physician services like traditional Medicare fee-for-service, but typically also offer additional services such as coverage for dental care and eyeglasses. In exchange for additional services and lower co-pays, members are restricted to in-network providers. More than one-third of Medicare enrollees choose Medicare Advantage plans.

The information used to measure the quality of care from Medicare Advantage plans included clinical quality measures based on administrative information such as medical charts involving more than 2 million enrollees. Those quality measures included items such as whether patients received recommended cancer screenings, whether high blood pressure was controlled and whether diabetes was treated adequately.

The analysis also examined surveys of more than 168,000 randomly sampled plan participants who were asked about their experiences with health care, prescription drug coverage and their plan. Those measures included the ability to get care, the ability to get care quickly and getting needed drugs.

Across most measures, people enrolled in the two higher-premium plan tiers reported similar or slightly better experiences on average than enrollees in the lower-premium categories. For example, people enrolled in the highest premium tiers were more likely to receive annual flu shots.

However, on one measure, lower-cost plans offered better care. People enrolled in lower-tiered plans received better care on average for osteoporosis than their peers enrolled in higher-premium plans.

Given that many high- and low-quality plans were found in each of the premium tiers we studied, the premium cost is a poor proxy for assessing the quality of a Medicare Advantage plan,” Haviland said. “Making plan quality information more accessible and salient to consumers is a key to reducing consumers’ costs while improving quality.”

Support for the study was provided by the federal Centers for Medicare & Medicaid Services. Other authors of the study are Sai Ma of Humana, and David J. Klein, Nathan Orr and Marc N. Elliott, all of RAND.

RAND Health Care promotes healthier societies by improving health care systems in the United States and other countries.

JOURNAL

JAMA Health Forum

DOI

10.1001/jamahealthforum.2022.2826

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Association of Medicare Advantage Premiums With Measures of Quality and Patient Experience

Prosthetics design integrating 3D printing takes third place in international challenge

RIT student’s flexible limb socket design is recognized for improved performance and cost effectiveness

Grant and Award Announcement

ROCHESTER INSTITUTE OF TECHNOLOGY

Jade Myers Holding Prosthetic Limb — IMAGE: JADE MYERS, AN ENGINEERING DOCTORAL CANDIDATE AND MEMBER OF RIT’S LIVEABILITY LAB, RECENTLY PLACED THIRD IN THE INTERNATIONAL NTOPOLOGY-EOS RESPONSIBLE PART CHALLENGE. SHE WAS RECOGNIZED FOR HER IMPROVED PROSTHETIC DEVICE DESIGNED WITH LATTICE STRUCTURES. view more
CREDIT: A. SUE WEISLER/RIT

Jade Myers’ experience in Haiti several years ago helping refugees after a devastating earthquake left an impression that is inspiring her work today as a researcher in prosthetics and accessibility.

Myers, who uses 3D print technology to develop upper and lower limb prostheses for amputees, was a top three winner of the nTopology-EOS 2022 Responsible Part Challenge, an international design competition. Her project, improving prosthetic sockets with density-graded lattice, was recognized for its innovation and potential impact the new design could have.

Myers was one of the students from 28 colleges and universities across 16 countries who participated in the annual event featuring designs in light-weighting, thermal management, sustainable energy, architected materials, and industrial design categories.

The technology gets Myers one step closer to a distinctive type of prosthesis that is more functional than traditional designs. She created a variable-density lattice structure to improve the connection where the body meets the prosthetic device.

“Light-weighting is super important for people with limited muscle and bone structure, and this is one of the areas where 3D printing, in our experience, has been very positive. The devices are much lighter than those traditionally manufactured,” said Myers, a Ph.D. candidate in RIT’s Kate Gleason College of Engineering. She also teaches courses in the engineering college and participates in interdisciplinary projects taking place at the LiveAbility Lab, an initiative based in the university’s Partnership for Effective Access Technology Research and Development.

There are several types of prosthetic sockets designed to interface with residual limbs. A more recent style developed is called a compression-release-stabilized (CRS) socket. Compression on either side of the humerus bone, for example, helps stabilize the prosthesis, and release areas ensure the soft tissue has a place to emerge.

“That is where this lattice structure comes in,” she said. “There are better ways to precisely control compression by changing the density of the lattice structure.”

Picking up items with a prosthesis means weight is added causing uneven pressure, or weight-load, concentrated on the far end of the bone. Adjusting pressure along the length of the bone and device can increase utility and range of motion, plus ease pain on the compressed tissue.

Inspiration for her new socket design came from running shoes.

“I knew they were using lattice structures at Adidas for running shoes to adjust pressure in different areas of the foot based on sensor readings,” she said. “Where individuals were putting the most pressure on their feet, that is where they put the dense lattice to make it firmer. I thought, why can’t we do that with prosthetic sockets?”

Myers re-worked the idea to form a padded socket with varied areas of density in RIT’s AMPrint Center, a campus laboratory and research facility focusing on additive manufacturing and 3D print advances. After compression, pressure, fatigue, and new materials testing, she will begin prototyping 3D printed models.

“We want it to have both form and function,” she said.

When Myers first began work in prosthetics, she was part of a nonprofit health organization associated with RIT and was instrumental in helping clinicians in Haiti understand how 3D-printed prostheses could be added to their practice.

While there, she met Danie, a young woman who lost her arm during the earthquake in 2010. Myers was touched by her plight, but also saw her as someone with a will to live despite hardships and socio-cultural stigma encountered in her community because of her amputation.

“Danie inspired me. In Haiti it is very hard for a person to not only afford a prosthesis, but to get to a clinic. Some people are spending the night outside of the clinic waiting for them to create this device that takes several days for them to make,” said Myers. “Being able to manufacture the devices faster is one of the things we want to do. We want to be able to provide things people can afford, and that work well for them. The faster it happens, the sooner people like Danie can have the opportunity to wear these. It not only impacts them—it can have a ripple effect on families and their opportunities, too. It gives me greater drive, practically a desperation to do better faster because I have had the opportunity to see with my own eyes what a real difference it has potential to make for people. I can never imagine doing anything else with my life.”

Myers and Danie have remained in contact since meeting, now co-designing devices together. The two have become good friends, and Myers has visited Haiti on several occasions seeing her friend re-building her life. Myers expects to graduate with her doctoral degree in 2023.

Awareness, not mandatory GMO labels, shifts consumer preference

Peer-Reviewed Publication

CORNELL UNIVERSITY

ITHACA, N.Y. – Six years ago, the state of Vermont passed what turned out to be a short-lived law mandating disclosure of genetically modified organisms, or GMOs, on all food products. That law’s effect? A collective shrug of the shoulders.

That doesn’t mean people don’t care about whether GMO ingredients are in their food, according to new Cornell research. Although the mandatory labeling law didn’t change consumer purchasing patterns, the researchers found that the increased consumer awareness caused by the legislation, coupled with existing non-GMO labeling, actually did shift preferences.

“For the consumers who care about this non-GMO attribute, they already have a relevant information signal available in the form of the non-GMO label,” said Jura Liaukonyte, the Dake Family Associate Professor in the Charles H. Dyson School of Applied Economics and Management.

“That’s when the switching happens,” Liaukonyte said, “and this switching is triggered by a heightened awareness through these legislative conversations.”

“GMO and non-GMO Labeling Effects: Evidence From a Quasi-Natural Experiment,” published Aug. 29 in Marketing Science. Liaukonyte’s co-authors were Aaron Adalja, assistant professor of food and beverage management in the Cornell Peter and Stephanie Nolan School of Hotel Administration; Emily Wang of the University of Massachusetts, Amherst; and Xinrong Zhu, of Imperial College Business School. Both Dyson and the Nolan School are in the Cornell SC Johnson College of Business.

The group’s key finding: An increase in consumer awareness around GMO-related topics – even in states that didn’t ultimately pass GMO labeling laws – is linked to an increase in demand for non-GMO products. And that difference can be quantified: They found that 36% of new non-GMO product adoption can be explained by differences in consumer awareness tied to legislative activity.

“What’s really interesting is the way legislative activity essentially generates consumer awareness,” Adalja said. “In the paper, we differentiate between this ‘indirect awareness effect’ and the direct effect of labeling, and we show that indirect awareness – in this case, the labeling legislation being discussed in the media – is really the primary mechanism by which we find consumer preferences are shifting.”

Over the last three decades, GMO labeling has become an increasingly important topic of public and political debate. The paper cites a 2016 National Academy of Sciences report finding no scientific evidence that GMO foods are less healthy or safe than non-GMO products; however, on Jan. 1, 2022, the United States mandated disclosure labels on all foods that contain GMOs.

The controversy over GMOs sparked several state-level labeling initiatives over the years, but Vermont was the only state to successfully pass and implement a labeling law. The law took effect July 1, 2016, but was quickly preempted by the National Bioengineered Food Disclosure Standard, signed into law by President Barack Obama on July 29, 2016.

For their study, the researchers analyzed GMO labeling in three steps. They first examined the relationship between the adoption rate of newly introduced non-GMO products and consumer awareness at the time of introduction. These products are identified by the “Non-GMO Project Verified” label, a certification from the third-party nonprofit Non-GMO Project, which has been used since 2010.

Then they analyzed the natural experiment condition created in the run-up to Vermont adopting its GMO labeling law in 2016, to gauge the relationship between product demand and the information available via on-the-ground efforts related to the legislation. The increase in demand tied to increased awareness was significant, the authors found.

And finally, the authors looked into whether actual adoption of the Vermont law – GMO labels appearing on store shelves – resulted in any additional demand for non-GMO or GMO products. It did not.

Previous studies, conducted via questionnaires or in laboratory settings, indicated that GMO labeling would result in big swings in consumer preference, but the Cornell researchers’ study in the field found a more subtle change.

“It’s difficult to approximate in the lab the complexity of the actual marketplace with its many co-existing information signals,” Liaukonyte said.

Adalja said the role of legislative discussion around GMO labeling – even in states that didn’t ultimately adopt labeling laws – was compelling.

“That has some important implications,” he said. “It’s another mechanism lawmakers need to consider when designing and debating policies that aim to change preferences of consumers.”

They also suggest that voluntary non-GMO labels – increasingly common over the last dozen years – may have provided a sufficient disclosure mechanism even without mandatory GMO labeling.

For additional information, see this Cornell Chronicle story.

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