Table 4. Association of Medicare Advantage Special Needs Plans and Non–Special Needs Plans vs Traditional Medicare With Ambulatory Care Access and Quality for Beneficiaries With Disability Entitlement, 2015-2018.
| Variable | Unadjusted results, weighted % | Adjusted marginal difference (95% CI)a | ||||
|---|---|---|---|---|---|---|
| Special needs plan | Non–special needs plan | Traditional Medicare | P valueb | Special needs plan | Non–special needs plan | |
| Accessc | ||||||
| Usual source of care | 86.7 | 92.3 | 84.9 | <.001 | 1.1 (–2.7 to 4.9) | 5.5 (3.3 to 7.7) |
| Usual source of care is PCC | 69.4 | 81.6 | 70.1 | <.001 | –0.7 (–5.9 to 4.4) | 9.3 (4.5 to 14.0) |
| Specialist visit | 41.8 | 57.7 | 44.8 | <.001 | 0.0 (–7.8 to 7.8) | 5.9 (1.3 to 10.5) |
| Quality | ||||||
| Annual cholesterol screend | 88.3 | 91.7 | 87.1 | .08 | 1.3 (–2.3 to 4.9) | 2.8 (0.2 to 5.4) |
| Annual flu shote | 57.2 | 63.5 | 51.1 | <.001 | 7.9 (0.2 to 15.6) | 11.3 (5.0 to 17.6) |
| Colon cancer screeningf | 66.9 | 69.3 | 54.4 | <.001 | 13.1 (5.6 to 20.5) | 11.4 (5.5 to 17.4) |
Abbreviation: PCC, primary care clinician.
We estimated multivariable logistic regression models for each outcome that also adjusted for the characteristics listed in Table 2 (with race and ethnicity collapsed into minority vs other). We added fixed effects for the states that beneficiaries resided in to control for state policy differences and state differences in supply of medical services, clinician practice intensity, and coding intensity. We included year fixed effects to control for secular trend and adjusted our P values for the complex survey design of the Medicare Current Beneficiary Survey and intra-person correlation over time. We used Stata's Margins command to report our results as the marginal difference of Medicare Advantage vs traditional Medicare for the dependent variables by modeling the response in the dependent variables to the exposure variable at the population means.
On a χ2 test for difference in proportions across Medicare Advantage Special Needs Plan vs Medicare Advantage non–special needs plan vs traditional Medicare.
Unweighted sample n = 6257. Met baseline study inclusion and responded to Medicare Current Beneficiary Survey questions for outcome variables.
Unweighted sample n = 2388. Met baseline study inclusion and exclusion criteria and self-reported having diabetes, ischemic heart disease, or heart failure and responded to Medicare Current Beneficiary Survey questions for outcome variable.
Unweighted sample n = 6019. Met baseline study inclusion and exclusion criteria and responded to Medicare Current Beneficiary Survey question for outcome variable.
Fecal occult blood test at home or physician’s office or colonoscopy or sigmoidoscopy within past 5 years, excluding patients who self-reported having colon cancer or were younger than 45 years. Unweighted sample n = 2840 for patients who met above criteria as well as baseline study inclusion and exclusion criteria and responded to Medicare Current Beneficiary Survey questions for outcome variable.