Medicare Advantage, traditional Medicare,
and Part D

More than half of Medicare beneficiaries are enrolled in Medicare Advantage (MA), and nearly four out of five Medicare beneficiaries are enrolled in a Part D plan.

As these programs continue to grow, policymakers, plans, providers, manufacturers, and other healthcare stakeholders need rigorous data and subject matter expertise to evaluate how legislative and regulatory proposals may affect patient access, provider and plan revenue, utilization, quality, risk adjustment, and overall Medicare program spending.

McDermott+ combines deep knowledge of Medicare policy with sophisticated analytic skills and comprehensive Medicare datasets, allowing clients to assess trends and policy impacts across traditional Medicare, Medicare Advantage, and Part D.

 
Together, these datasets allow us to track patients, providers, services, diagnoses, plans, and prescription drug use over time. This information creates a powerful foundation for understanding how care is delivered across the Medicare program and how policy changes may affect stakeholders. These datasets can also be combined with publicly available information. This includes with MA and Part D plan enrollment, Star Ratings, and benefits to provide a comprehensive picture of the competitive landscape, or with hospital and facility level information to better understand trends among providers.

We use MA encounter and enrollment data to assess care patterns, utilization, diagnoses, outcomes, and plan-level trends. This includes evaluating how new regulatory and legislative proposals related to MA payment policy, risk adjustment, and quality metrics may impact beneficiary access and Medicare spending. We also use this data to compare utilization across MA organizations, and to identify differences in the care provided between MA and traditional Medicare.

We use traditional Medicare (also known as Original Medicare or Medicare fee-for-service) claims to evaluate practice patterns, beneficiary spending and utilization, and identify trends in the Medicare program. This includes evaluating how new regulatory and legislative proposals may impact patient access, provider revenue, and Medicare spending. We routinely use this traditional Medicare data to support device manufacturers, providers, and trade associations in developing comment letters to submit to CMS on proposed rules related to Medicare payment systems. We also use traditional Medicare data as a baseline to compare against trends observed in Medicare Advantage.

Part D data provides a detailed view of prescription drug utilization, spending, formulary design, and beneficiary access across the Medicare prescription drug benefit.

We use prescription drug event data and formulary information to track drug-level trends including formulary placement and total utilization for individual Part D plans, beneficiary access and cost-sharing for medications, and to evaluate how potential new policies or regulations may impact Part D plans, manufacturers, pharmacies, patients and Medicare spending.

Potential analyses include tracking drug spending and volume at the national drug code level, evaluating formulary placement, comparing utilization across plans or regions, and supporting advocacy related to Part D payment policy, benefit design, and regulatory changes.

When combined, Medicare Advantage encounter data, traditional Medicare claims, and Part D event data offer a comprehensive view of utilization, behavior, and trends across the Medicare program.

We use these datasets to provide a more complete picture of the Medicare program by analyzing traditional Medicare, Medicare Advantage, and Part D separately or together.

We help clients:

• Evaluate the potential impact of new legislative or regulatory proposals
• Compare utilization, access, and outcomes across MA and traditional Medicare
• Analyze plan-, market-, or industry-wide trends
• Assess changes to MA risk adjustment, payment policy, or Part D benefit design
• Understand patient journeys for populations of interest
• Examine variation by geography, site of service, provider type, or plan

These nuanced insights equip clients to effectively pursue business and policy objectives.

Medicare Advantage and Part D policy development follows a recurring annual cycle. Data analysis can be especially valuable at key points throughout the year.