Changing Medicare scene has implications for real-world data

Health data sources must keep pace with consumer trends, such as an increasing number of retirees on Medicare Advantage plans, to provide a trusted longitudinal view of patients

By | 2 minute read | November 23, 2021

Focused two women in medical protective masks working in office.

Every initiative to improve healthcare requires high-quality data. Whether an organization is seeking improved outcomes, higher quality or lower costs, it should start with in-depth, reliable and representative data.

This means that health data sources must be as dynamic as healthcare is. Organizations must analyze data that reflects their populations, which are constantly evolving. One example of this in the United States is the evolution of Medicare Advantage Plans.

Medicare Advantage Plans, also known as Part C, are an alternative to traditional Medicare coverage for people age 65 and older. Private insurance companies run Medicare Advantage Plans, which bundle Medicare Part A (hospital insurance), Medicare Part B (outpatient insurance) and usually Medicare Part D (drug coverage).1 Private companies have traditionally offered Medicare supplemental (also known as “Medigap”) as a form of extra coverage.

But, as individuals and self-insured employers continue to make decisions based on risk and cost, Medicare Advantage is becoming more popular. Consider:

  • Enrollment in Medicare Advantage has doubled between 2010 and 2020, comprising nearly four in ten (39%) of all Medicare beneficiaries.2
  • In 2021, more than 26 million people are enrolled in Medicare Advantage plans, which is 42% of the total Medicare population.3
  • Some estimates show more than half of Medicare enrollees will be in Medicare Advantage plans by 2030.4

These trends have important implications for health data sources. Organizations need to be able to track these patients over time – regardless of their health insurance choices – for more complete analyses of populations.

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The growing Medicare population tends to have high utilization rates of pharmaceutical and device products. When demonstrating the value of their products to healthcare decision makers, life sciences organizations need longitudinal data that truly represents the underlying population and captures the market trends of Medicare enrollment.

When it comes to reliable real-world data, a combined Medicare Supplemental and Medicare Advantage database as a single source can help researchers capture insights and develop value propositions from a broader, more representative spectrum of Medicare enrollees. It can also enable researchers to compare cost and utilization between Supplemental and Advantage enrollees, either pre-post Advantage enrollment or within the same timeframe.

Here are a few examples of use cases where it is particularly important to include Medicare Advantage participants in longitudinal records for privately insured Americans:

  • A life sciences company could monitor treatments for chronic conditions over time and evaluate outcomes and costs and incidence of adverse events.
  • A life sciences company could more accurately size and segment the potential market for their product.
  • A government agency could better understand the healthcare costs and utilization of the populations it serves
  • A payer can compare costs associated with retirees in Medicare Advantage plans versus those enrolled in other insurance options to model budgetary impact and inform benefit plan design.

When the data are robust and reliable, there are countless ways to stratify and evaluate the data to inform research or efforts to improve clinical and financial outcomes.

  2. Kaiser Family Foundation “A Dozen Facts About Medicare Advantage in 2020” by Meredith Freed, Anthony Damico and Tricia Neuman. Published Jan 13, 2021.
  3. Kaiser Family Foundation “ Medicare Advantage in 2021: Enrollment Update and Key Trends” by Meredith Freed, Jeannie Fuglesten Biniek, Anthony Damico and Tricia Neuman. Published June 21, 2021.
  4. Kaiser Family Foundation “ Medicare Advantage in 2021: Enrollment Update and Key Trends” by Meredith Freed, Jeannie Fuglesten Biniek, Anthony Damico and Tricia Neuman. Published June 21, 2021.