Favorable Risk Selection in Medicare Advantage: The Effect of Allowing Non-Medical Services

Published Online:https://doi.org/10.1287/msom.2023.0474

References

  • Adida E (2024) Indication-based pricing for multi-indication drugs. Management Sci. 70(11):7506–7523.LinkGoogle Scholar
  • Adida E, Bravo F (2019) Contracts for healthcare referral services: Coordination via outcome-based penalty contracts. Management Sci. 65(3):1322–1341.LinkGoogle Scholar
  • Adida E, Bravo F (2023) Primary Care First initiative: Impact on care delivery and outcomes. Manufacturing Service Oper. Management 25(4):1471–1488.LinkGoogle Scholar
  • Adida E, Mamani H, Nassiri S (2016) Bundled payment vs. fee-for-service: Impact of payment scheme on performance. Management Sci. 63(5):1606–1624.LinkGoogle Scholar
  • Andritsos DA, Tang CS (2018) Incentive programs for reducing readmissions when patient care is co-produced. Production Oper. Management 27(6):999–1020.CrossrefGoogle Scholar
  • Aswani A, Shen ZJM, Siddiq A (2019) Data-driven incentive design in the Medicare Shared Savings Program. Oper. Res. 67(4):1002–1026.AbstractGoogle Scholar
  • Ata B, Killaly BL, Olsen TL, Parker RP (2013) On hospice operations under Medicare reimbursement policies. Management Sci. 59(5):1027–1044.LinkGoogle Scholar
  • ATI Advisory (2020) Providing non-medical supplemental benefits in Medicare Advantage: A roadmap for plans and providers. https://bit.ly/4naxKsT.Google Scholar
  • Baker LC, Bundorf MK, Devlin AM, Kessler DP (2016) Medicare Advantage plans pay hospitals less than traditional Medicare pays. Health Affairs 35(8):1444–1451.CrossrefGoogle Scholar
  • Bastani H, Goh J, Bayati M (2019) Evidence of upcoding in pay-for-performance programs. Management Sci. 65(3):1042–1060.LinkGoogle Scholar
  • Bastani H, Bayati M, Braverman M, Gummadi R, Johari R (2016) Analysis of Medicare pay-for-performance contracts. Preprint, submitted September 15, https://doi.org/10.2139/ssrn.2839143.Google Scholar
  • Bhaumik D, Grabowski DC (2025) Long-term services and supports in supplemental benefits in Medicare Advantage plans. JAMA Network Open 8(8):e2526406.CrossrefGoogle Scholar
  • Blumenthal D, Davis K, Guterman S (2015) Medicare at 50—Origins and evolution. New Engl. J. Med. 372(5):479–486.CrossrefGoogle Scholar
  • Braveman P, Egerter S, Williams DR (2011) The social determinants of health: Coming of age. Annual Rev. Public Health 32:381–398.CrossrefGoogle Scholar
  • Bravo F, Levi R, Perakis G, Romero G (2023) Care coordination for healthcare referrals under a shared-savings program. Production Oper. Management 32(1):189–206.CrossrefGoogle Scholar
  • Brown J, Duggan M, Kuziemko I, Woolston W (2014) How does risk selection respond to risk adjustment? New evidence from the Medicare Advantage program. Amer. Econom. Rev. 104(10):3335–3364.CrossrefGoogle Scholar
  • Byhoff E, Taylor LA (2018) How are Massachusetts community-based organizations responding to the health care sector’s entry into social determinants of health. Technical report, Blue Cross Blue Shield Foundation, MA.Google Scholar
  • CMS (2019) CMS finalizes Medicare Advantage and Part D payment and policy updates to maximize competition and coverage. CMS Press Release. https://bit.ly/46yVdhw.Google Scholar
  • CMS (2022) Understanding Medicare Advantage Plans. CMS Publications. https://www.medicare.gov/publications/12026-Understanding-Medicare-Advantage-Plans.pdf.Google Scholar
  • Cooper AL, Trivedi AN (2012) Fitness memberships and favorable selection in Medicare Advantage plans. New Engl. J. Med. 366(2):150–157.CrossrefGoogle Scholar
  • Cutler DM, Zeckhauser RJ (2000) The anatomy of health insurance. Culyer AJ, Newhouse JP, eds. Handbook of Health Economics, vol. 1 (Elsevier, Amsterdam), 563–643.Google Scholar
  • Einav L, Finkelstein A (2011) Selection in insurance markets: Theory and empirics in pictures. J. Econom. Perspect. 25(1):115–138.CrossrefGoogle Scholar
  • Fang H, Keane MP, Silverman D (2008) Sources of advantageous selection: Evidence from the medigap insurance market. J. Political Econom. 116(2):303–350.CrossrefGoogle Scholar
  • Geruso M, Layton T (2020) Upcoding: Evidence from Medicare on squishy risk adjustment. J. Political Econom. 128(3):984–1026.CrossrefGoogle Scholar
  • Gold M (2001) Medicare+ Choice: An interim report card. Health Affairs 20(4):120–138.CrossrefGoogle Scholar
  • Guo P, Tang CS, Wang Y, Zhao M (2019) The impact of reimbursement policy on social welfare, revisit rate, and waiting time in a public healthcare system: Fee-for-service versus bundled payment. Manufacturing Service Oper. Management 21(1):154–170.LinkGoogle Scholar
  • Hostetter M, Klein S (2020) CHRONIC Care Act prompts some Medicare Advantage plans to incorporate social services. The Commonwealth Fund (January 9), https://doi.org/10.26099/ghes-rk53.Google Scholar
  • Hu X, Munkin MK, Trivedi PK (2015) Estimating incentive and selection effects in the Medigap insurance market: An application with Dirichlet process mixture model. J. Appl. Econometrics 30(7):1115–1143.CrossrefGoogle Scholar
  • Huang J, Gupta D (2021) The benefits-value-advisor program for shoppable medical services. Preprint, submitted March 2, https://doi.org/10.2139/ssrn.3798075.Google Scholar
  • Jiang H, Pang Z, Savin S (2012) Performance-based contracts for outpatient medical services. Manufacturing Service Oper. Management 14(4):654–669.LinkGoogle Scholar
  • Jiang H, Pang Z, Savin S (2025) Horizontal consolidation in healthcare markets: Can performance incentives preserve access to care? Production Oper. Management 35(2):586–605. CrossrefGoogle Scholar
  • Kc DS, Scholtes S, Terwiesch C (2020) Empirical research in healthcare operations: Past research, present understanding, and future opportunities. Manufacturing Service Oper. Management 22(1):73–83.LinkGoogle Scholar
  • Keskinocak P, Savva N (2020) A review of the healthcare-management (modeling) literature published in Manufacturing & Service Operations Management. Manufacturing Service Oper. Management 22(1):59–72.LinkGoogle Scholar
  • Koma W, Cubanski J, Neuman T (2021) A snapshot of sources of coverage among Medicare beneficiaries in 2018. Kaiser Family Foundation (March 23).Google Scholar
  • McGovern L, Miller G, Hughes-Cromwick P (2014) The relative contribution of multiple determinants to health outcomes. Health Affairs 21.Google Scholar
  • Medicare Payment Advisory Commission (2025) Supplemental benefits in Medicare Advantage. Chapter 2 in Report to the Congress: Medicare and the Health Care Delivery System.Google Scholar
  • Meyers DJ, Trivedi AN, Mor V (2019) Limited medigap consumer protections are associated with higher reenrollment in Medicare Advantage plans. Health Affairs 38(5):782–787.CrossrefGoogle Scholar
  • Nassiri S, Adida E, Mamani H (2022) Reference pricing for healthcare services. Manufacturing Service Oper. Management 24(2):921–937.LinkGoogle Scholar
  • Neuman P, Jacobson GA (2018) Medicare Advantage checkup. New Engl. J. Med. 379(22):2163–2172.CrossrefGoogle Scholar
  • Newhouse JP, McGuire TG (2014) How successful is Medicare Advantage? Milbank Quart. 92(2):351–394.CrossrefGoogle Scholar
  • OECD (2024) Society at a Glance 2024: OECD Social Indicators (OECD Publishing, Paris).CrossrefGoogle Scholar
  • Park S, Basu A, Coe N, Khalil F (2017) Service-level selection: Strategic risk selection in Medicare Advantage in response to risk adjustment. NBER Working Paper No. 24038, National Bureau of Economic Research, Cambridge, MA.Google Scholar
  • Rajagopalan S, Tong C (2022) Payment models to coordinate healthcare providers with partial attribution of outcome costs. Manufacturing Service Oper. Management 24(1):600–616.LinkGoogle Scholar
  • Reid RO, Deb P, Howell BL, Conway PH, Shrank WH (2016) The roles of cost and quality information in Medicare Advantage plan enrollment decisions: An observational study. J. Gen. Intern. Med. 31(2):234–241.CrossrefGoogle Scholar
  • Roberts ET, Macneal E, Lovelace J (2024) Medicare advantage supplemental benefits for dual-eligible beneficiaries and recommendations for reform. JAMA Health Forum 5(9):e242761.CrossrefGoogle Scholar
  • Savva N, Tezcan T, Yıldız Ö (2019) Can yardstick competition reduce waiting times? Management Sci. 65(7):3196–3215.LinkGoogle Scholar
  • She Z, Ayer T, Montanera D (2022) Can big data cure risk selection in healthcare capitation program? A game theoretical analysis. Manufacturing Service Oper. Management 24(6):3117–3134.LinkGoogle Scholar
  • She Z, Ayer T, Gokpinar B, Hughes DR (2024) Strategic cross-subsidization in healthcare capitation programs: Evidence from Medicare advantage. Manufacturing Service Oper. Management 26(6):2085–2101.LinkGoogle Scholar
  • Skopec L, Ramos C, Aarons J (2019) Are MA plans using new supplemental benefit flexibility to address enrollees’ health-related social needs? The Urban Institute, Washington, DC.Google Scholar
  • Soltani M, Batt RJ, Bavafa H (2025) Quality improvement spillovers: Evidence from the hospital readmissions reduction program. Management Sci. 71(7):6112–6130.LinkGoogle Scholar
  • Tucher EL, Meyers DJ, Trivedi AN, Gottlieb LM, Thomas KS (2024) The impacts of supplemental benefits on Medicare Advantage plan composition. Amer. J. Managed Care 30(7):e210–e216.CrossrefGoogle Scholar
  • Willink A, DuGoff EH (2018) Integrating medical and nonmedical services—The promise and pitfalls of the CHRONIC Care Act. New Engl. J. Med. 378(23):2153–2155.CrossrefGoogle Scholar
  • Yang Z, Zhu E, Cheng D, Price M, Alegria M, Hsu J, Newhouse JP, Fung V (2024) County-level enrollment in Medicare Advantage plans offering expanded supplemental benefits. JAMA Network Open 7(9):e2433972.CrossrefGoogle Scholar
  • Zorc S, Chick S, Hasija S (2023) Outcomes-based reimbursement policies for chronic care pathways. INSEAD Working paper.Google Scholar
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