Which medicare advantage enrollees are at highest one-year mortality risk?

Natalie C Ernecoff; Rebecca Anhang Price; David J Klein; Amelia M Haviland; Debra Saliba; Nate Orr; Jennifer Gildner; Sarah Gaillot; Marc N Elliott

doi:10.1016/j.archger.2024.105454

Which medicare advantage enrollees are at highest one-year mortality risk?

Arch Gerontol Geriatr. 2024 Apr 22:124:105454. doi: 10.1016/j.archger.2024.105454. Online ahead of print.

Authors

Natalie C Ernecoff¹, Rebecca Anhang Price², David J Klein³, Amelia M Haviland⁴, Debra Saliba⁵, Nate Orr³, Jennifer Gildner³, Sarah Gaillot⁶, Marc N Elliott⁷

Affiliations

¹ RAND Corporation, 4570 Fifth Avenue Suite 600, Pittsburgh, PA 15213, United States.
² RAND Corporation, 1200 S Hayes Street, Arlington, VA 22202, United States.
³ RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States.
⁴ RAND Corporation and Carnegie Mellon University, 4800 Forbes Avenue, Hamburg Hall 2214, Pittsburgh, PA 15213, United States.
⁵ RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States; University of California Los Angeles Borun Center, 10945 Le Conte Ave, Suite 2339, Los Angeles, CA 90095, United States; Los Angeles Veterans Administration GRECC, Los Angeles, CA, United States.
⁶ Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, MD 21244, United States.
⁷ RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States. Electronic address: elliott@rand.org.

PMID: 38703702
DOI: 10.1016/j.archger.2024.105454

Abstract

Background: While a number of tools exist to predict mortality among older adults, less research has described the characteristics of Medicare Advantage (MA) enrollees at higher risk for 1 year mortality.

Objectives: To describe the characteristics of MA enrollees at higher mortality risk using patient survey data.

Research design: Retrospective cohort.

Subjects: MA enrollees completing the 2019 MA Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey.

Measures: Linked demographic, health, and mortality data from a sample of MA enrollees were used to predict 1-year mortality risk and describe enrollee characteristics across levels of predicted mortality risk.

Results: The mortality model had a 0.80 c-statistic. Mortality risks were skewed: 6 % of enrollees had a ≥ 10 % 1-year mortality risk, while 45 % of enrollees had 1 % to < 5 % 1-year mortality risk. Among the high-risk (≥10 %) group, 47 % were age 85+ versus 12 % among those with mortality risk <5 %. 79 % were in fair or poor self-rated health versus 29 % among those with mortality risk of <5 %. 71 % reported needing urgent care in the prior 6 months versus 40 % among those with a mortality risk of 1 to<5 %.

Conclusions: Relatively few older adults enrolled in MA are at high 1-year mortality risk. Nonetheless, MA enrollees over age 85, in fair or poor health, or with recent urgent care needs are far more likely to be in a high mortality risk group.

Keywords: Medicare; Mortality; Prediction; Survey.