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Quality Assessments by Sick and Healthy Beneficiaries in Traditional Medicare and Medicare Managed Care

Keenan, Patricia S. PhD*; Elliott, Marc N. PhD; Cleary, Paul D. PhD*; Zaslavsky, Alan M. PhD; Landon, Bruce E. MBA, MSc‡§

doi: 10.1097/MLR.0b013e3181a39415
Original Article

Background: The Centers for Medicare & Medicaid Services pays for services provided through traditional fee-for-service (FFS) Medicare and managed care plans (Medicare Advantage [MA]). It is important to understand how financing and organizational arrangements relate to quality of care.

Objectives: To compare care experiences and preventive services receipt in traditional Medicare and MA for healthy and sick beneficiaries.

Methods: Randomly selected beneficiaries responded to the 2003 and 2004 Consumer Assessments of Healthcare Providers and Systems (CAHPS®) surveys. We analyzed 237,221 MA responses (80% response rate) and 153,535 from FFS (68% response rate). We compared case-mix-adjusted CAHPS scores between FFS and MA for healthy and sick beneficiaries on 7 CAHPS measures of care experiences and 3 preventive service measures.

Results: CAHPS scores were lower in MA than FFS for all care experience measures except office wait time. The sick had less favorable care experiences than the healthy for all measures, but were more likely to receive each preventive service (P < 0.001). FFS-MA differences were larger for the sick than the healthy for 5 of 7 experience measures (P < 0.05), and were twice as large for physician ratings and interactions. Office wait time and rates of immunization were better in MA than FFS (P < 0.001), with no differences between healthy and sick groups.

Conclusions: Beneficiaries in health plans report less favorable care experiences than those in FFS, particularly among the sick, but preventive service measures are higher in MA. The Centers for Medicare and Medicaid Services should strengthen efforts to improve care experiences of the sick, particularly in MA, and preventive service receipt in FFS.

From the *Division of Health Policy and Administration, Yale School of Public Health, Yale School of Medicine, New Haven, Connecticut; †RAND Corporation, Santa Monica, California; ‡Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts; and §Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts.

Supported by a contract (500-01-0020) from the Centers for Medicare & Medicaid Services (CMS) to Westat/Harvard University and through a subcontract to RTI International, which subcontracted from the University of Wisconsin (contract number 2-5IU-7903.) CMS funded the collection of Consumer Assessment of Health Plans Study Survey data, collected the data, and approved the manuscript topic. CMS personnel reviewed the manuscript before submission for nondisclosure of personally identifiable information. We gratefully acknowledge Amy Heller, Ted Sekscenski, and Elizabeth Goldstein of CMS and members of the Medicare CAHPS project teams for their efforts and expertise in conducting the surveys on which these analyses are based.

Reprints: Patricia S. Keenan, PhD, Yale School of Public Health, Yale School of Medicine; 60 College St. 300C New Haven CT 06520. E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.