Table 4. Contract Characteristics of Medicare Beneficiaries With ESRD and Enrolled in Medicare Advantage in 2021.
| Characteristics | Prevalent ESRD, switched to Medicare Advantage (n = 63 121) | Incident ESRD, enrolled in Medicare Advantage (n = 32 208) |
|---|---|---|
| County-level MA penetration rate, mean (SD), %a | 46.4 (11.5) | 48.3 (11.3) |
| Plan type | ||
| HMO or HMO POS | 63.6 | 62.1 |
| Local PPO | 28.8 | 29.6 |
| Regional PPO | 4.3 | 5.5 |
| Other (MSA, Medicare-Medicaid plan, national PACE, PFFS) | 3.3 | 2.6 |
| Multistate | 57.4 | 60.7 |
| Parent organization | ||
| UnitedHealth Group, Inc | 31.3 | 28.1 |
| Humana Inc | 24.8 | 21.2 |
| Centene Corporation | 12.2 | 5.7 |
| Anthem Inc | 9.5 | 6.5 |
| CVS Health Corporation | 7.2 | 8.9 |
| Cigna | 2.5 | 2.9 |
| Other | 12.5 | 26.7 |
| Enrollment in MA contracts with >0% special needs plan | 80.5 | 67.9 |
| MA star rating, mean (SD)b | 3.8 (0.5) | 3.9 (0.5) |
| For profit | 91.9 | 79.2 |
| Contract age, yc | ||
| ≤5 | 25.7 | 13.7 |
| 6-10 | 14.8 | 11.1 |
| >10 | 59.5 | 75.2 |
| Integrated system, %d | 4.6 | 10.7 |
| Dialysis facility network breadth, mean (SD) in 2020e | 63.8 (23.6) | 68.0 (21.3) |
| Narrow dialysis facility networks in 2020f | 7.8 | 3.8 |
Abbreviations: ESRD, end-stage renal disease; HMO, health maintenance organization; MA, Medicare Advantage; MSA, medical savings account; PACE, Program of All-Inclusive Care for the Elderly; PFFS, private fee for service; POS, point of service; PPO, preferred provider organization.
Medicare Advantage penetration rate is defined as the county-level proportion of all Medicare beneficiaries enrolled in MA.
Medicare Advantage star ratings range between 1 and 5 stars (1 star is the lowest rating and 5 stars is the highest). Ratings are calculated by the Centers for Medicare & Medicaid Services on the basis of 30 to 35 measures of satisfaction and quality outcomes.
Contract age refers to the number of years a plan or contract has been operating, which is calculated as the difference between the contract effective date and 2021.
Integrated system refers to MA contracts that were associated with a health system or hospital.
Dialysis facility network breadth is defined as the proportion of dialysis facilities located in each MA contract’s service area that were included in that contract’s network.
Narrow networks are defined as those that included less than or equal to 25% of available dialysis facilities in a given contract’s service area.