Primary care delivery is similar across all Medicare patient mixes

Care delivery, care coordination, and administrative challenges were similar across primary care physicians serving traditional Medicare patients and those serving Medicare Advantage patients, a Commonwealth Fund brief found.

Unlike traditional Medicare, Medicare Advantage plans receive capitated payments from the government to cover beneficiaries’ care. Medicare Advantage plans may use the funds to help providers improve care coordination or reduce their time on administrative tasks. Plans may be more likely to incentivize primary care physicians as they help prevent expensive long-term health issues.

The brief used data from the Commonwealth Fund’s 2022 International Health Policy Survey of Primary Care Physicians and 2021 Medicare claims data to assess if primary care physicians who primarily serve Medicare Advantage patients report differences in care delivery, care coordination, and administrative burden compared to those serving traditional Medicare patients.

Among 453 primary care physicians, most saw both Medicare Advantage and traditional Medicare patients. One in ten physicians saw only Medicare Advantage beneficiaries, one in 20 saw only traditional Medicare beneficiaries, and one in four saw similar shares of Medicare Advantage and traditional Medicare patients.

Physicians who mainly served Medicare Advantage patients were significantly more likely to work in community health centers or clinics and practices recognized as patient-centered medical homes or advanced primary care practices.

Managing care for patients with chronic conditions was similar among physicians who mostly saw Medicare Advantage patients and those who mostly saw traditional Medicare patients. A similar share said they develop treatment plans with patients they can carry out in their daily lives, provide patients with written instructions about how to manage their care at home, and contact patients between visits to monitor their condition.

However, physicians treating mostly Medicare Advantage patients were more likely to note their patients’ self-management goals in their medical records than physicians primarily serving traditional Medicare patients (52 percent versus 40 percent).

Physicians serving primarily Medicare Advantage patients were also more likely to receive notifications when their patients were seen in other settings, such as receiving after-hours care, visiting the emergency room, or being admitted to the hospital.

Regardless of their patient mix, most primary care physicians are not screening patients for social needs. Less than half of all physicians said they regularly screen Medicare patients for social isolation or loneliness, domestic violence, transportation needs, food insecurity, financial security, and housing issues.

Physicians with more Medicare Advantage patients reported high rates of screening for domestic violence (48 percent) compared to those with an even patient mix (39 percent) and those mainly serving traditional Medicare patients (31 percent).

Similar shares of physicians with different patient mixes reported challenges with coordinating patient care with social services. Between 36 percent and 41 percent of physicians serving Medicare Advantage patients, traditional Medicare patients, and both said the lack of information about social service organizations in the community posed a challenge.

Similarly, more than three in ten physicians reported a lack of referral systems, inadequate staffing, too much paperwork, and a lack of follow-up from social service organizations as challenges.

At least half of physicians treating mostly Medicare Advantage patients, those treating mostly traditional Medicare patients, and those with a mix said the time spent on administrative issues related to insurance or claiming payments was a major problem. Similarly, over 60 percent of all primary care physicians said getting patients needed medications or treatments was difficult due to coverage restrictions.

Almost half of physicians reported the time spent documenting patient care or visits was a problem. Around a quarter of physicians said reporting clinical or quality care data to external entities and coordinating referrals with specialists were time-consuming problems.

The lack of differences between primary care physicians serving Medicare Advantage patients and physicians serving traditional Medicare patients suggests Medicare Advantage plans may have minimal influence on care delivery. Alternatively, these findings may indicate that a low number of Medicare Advantage patients are influencing how primary care physicians function, causing a spillover effect and impacting all their patients.