Quality of provider-offered Medicare Advantage plans

Introduction

Healthcare providers and payers continue to consolidate into larger firms. One type of consolidation, known as vertical integration, occurs when hospitals or health systems offer their own insurance products.1 Proponents argue that consolidation improves efficiency, but there is little evidence on the relationship between provider-offered health insurance and quality of care.2 Therefore, we compared the quality of provider-offered Medicare Advantage (MA) to that of insurer-offered contracts.

Methods

Using publicly available MA contract and enrolment files from the Centers for Medicare & Medicaid Services (CMS), we constructed a data set identifying all provider-offered contracts from 2011 to 2015 (n=2030 contract years). For the purposes of this study, provider-offered means that the parent organisation of the MA contract and provider organisation are or are owned by the same firm. To make this determination, we followed the approach of Frakt et al and Johnson et al.

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