Category Ranking
98%
Total Visits
921
Avg Visit Duration
2 minutes
Citations
20
Article Abstract
Background: Although Medicare Advantage (MA) plans provide coverage to >50% of Medicare beneficiaries, it is unclear whether MA claims can be used similarly to Medicare Fee-For-Service (FFS) claims for clinical outcomes assessment. In this study, we evaluate the accuracy of claims algorithms previously validated in FFS to assess comorbidities and outcomes in MA patients after aortic valve replacement.
Methods: We compared the concordance of 11 claims-based covariates (diabetes, hypertension, atrial flutter/fibrillation, myocardial infarction) and outcomes (stroke, disabling stroke, transient ischemic attack, major vascular complication, bleeding, permanent pacemaker implantation, death) among FFS and MA patients with the covariates and adjudicated outcomes in the multinational Evolut Low-Risk Trial (2016-2018). We used claims algorithms for 1-year outcomes and calculated sensitivity, specificity, positive predictive value, negative predictive value, and kappa, using adjudicated outcomes as the reference. We compared the kappa for MA versus FFS using the 2-sample -test with a significance level of <0.05.
Results: Among 1139 US patients aged 65+ years old in the Evolut Low-Risk Trial, 782 patients (175 MA and 607 FFS) were linked to claims data and had complete comorbidity data. Among all covariates, claims algorithms for covariates had sensitivities ≥85% for identifying diabetes, atrial flutter/fibrillation, and hypertension in MA and FFS. For the outcomes, sensitivities were ≥85% for bleeding (comprehensive), permanent pacemaker implantation, and death. The kappa was higher in MA versus FFS for diabetes (=0.03) and hypertension (=0.025) but was lower in myocardial infarction (<0.0001). There was no statistically significant difference in the kappa agreement between MA versus FFS for any of the selected outcomes.
Conclusions: Medicare claims have a similar level of kappa agreement in MA versus FFS for most covariates and outcomes. As patients shift to MA, ascertainment of outcomes using Medicare claims in postapproval studies remains valid for select outcomes.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC12092182 | PMC |
| http://dx.doi.org/10.1161/CIRCOUTCOMES.125.011991 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Do MA plans follow incentives to attract enrollee groups with new supplemental benefits?
Health Aff Sch
September 2025
Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA 90095, United States.
Introduction: The Medicare Advantage (MA) payment system gives rise to incentives for plans to attract and retain beneficiaries from minoritized racial and ethnic groups and those dually eligible for Medicaid (duals) by offering these groups additional benefits.
Methods: We examined how MA plans respond to these incentives using a 2020 policy change that granted broader flexibility in benefit design, allowing plans to offer Special Supplemental Benefits for the Chronically Ill (SSBCI).
Results: We found that plans with higher shares of patients from these groups were more likely to offer SSBCI benefits: a 1 SD increase in a plan's non-White share was associated with a 20.
Outcomes of Endovascular Revascularization for Chronic Limb-Threatening Ischemia in Medicare Advantage and Medicare Fee-For-Service Beneficiaries.
Circ Cardiovasc Qual Outcomes
September 2025
Division of Cardiology, Richard and Susan Smith Center for Outcomes Research, Beth Israel Deaconess Medical and Harvard Medical School, Boston, MA.
Moving from Medicaid Expansion Coverage to Medicare Can Be a Burdensome Transition: A Qualitative Study.
J Gen Intern Med
September 2025
Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
Background: The Affordable Care Act expanded Medicaid eligibility for low-income adults who are not Medicare eligible while leaving in place states' more restrictive dual eligibility criteria. When Medicaid expansion enrollees turn 65 and transition to Medicare as their primary insurer, they may lose Medicaid and face higher premiums and out-of-pocket costs, yet there is little understanding of how older adults navigate this change in insurance programs.
Objective: To investigate the experiences of Medicaid expansion enrollees who transitioned to Medicare coverage at age 65.
Older adults living with dementia enrolled in similar Medicare Advantage plans compared to those without dementia.
Alzheimers Dement Behav Socioecon Aging
June 2025
Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA.
Introduction: Medicare Advantage (MA) plan selection may differ between older adults with or without dementia in unexplored ways. This study aims to characterize MA plan choice among those with dementia.
Methods: We used the 2010 to 2018 waves of the Health and Retirement Study with linked Medicare enrollment data to identify MA respondents ≥ 65 years, with and without dementia.
The Quality Of Opioid Use Disorder Treatment In Medicare Is Low And Lags Behind Medicaid.
Health Aff (Millwood)
September 2025
Miku Fujita, Johns Hopkins University, Baltimore, Maryland.
The Centers for Medicare and Medicaid Services regularly assesses the quality of opioid use disorder (OUD) treatment received by Medicaid beneficiaries. However, to date, there has been no comprehensive assessment of Medicare OUD treatment. In 2022, 1.
View Article and Find Full Text PDF