New Study in AJMC Provides Further Evidence of the Effectiveness of Medicare Advantage Plans

A new joint study by America’s Health Insurance Plans (AHIP) and MedAssurant, Inc. shows the continued value of Medicare Advantage in lowering hospital readmission rates compared to outdated Medicare fee-for-service (FFS).

In the new study, published in the February issue of the American Journal of Managed Care (AJMC), unadjusted 30-day readmission rates for MA patients were approximately 14.5% from 2006-2008, 22% lower than FFS. Taking into account risk adjustment and demographic information, data from the same time period show MA 30-day readmission rates to be 13% to 20% lower than traditional Medicare FFS rates. The study was conducted by MedAssurant, Inc., and America’s Health Insurance Plans (AHIP).

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The transitional care interventions used by MA plans and improved communication among providers of care have been shown to play a role in reducing readmission rates and are being looked to as a model elsewhere in the health care system.

“Health plans have played a game changing role in bringing programs to the delivery system that are helping patients get appropriate follow-up care and avoid preventable hospital readmission,” said Karen Ignagni, President and CEO of AHIP.

The new study “Hospital Readmission Rates in Medicare Advantage Plans,” by Lemieux et al., aims to create a national benchmark for readmission rates among MA patients to make it possible to track continued progress in lowering MA readmission rates over time.

The AJMC study follows a series of studies by AHIP researchers and others comparing patterns of care among patients with Medicare Advantage coverage and in the FFS Medicare program. This includes a recent report published in Health Affairs that compares utilizations rates among beneficiaries with diabetes in an MA special-needs plan to similar beneficiaries in FFS Medicare. People with diabetes in the special-needs plan had more primary care office visits and fewer hospital admissions and readmissions than beneficiaries in FFS Medicare.

A recent AHIP publication, Innovations in Reducing Preventable Hospital Admissions, Readmissions, and Emergency Room Use, provides company specific examples of the types of programs and services that health plans have implemented to reduce preventable hospital admissions, readmissions, and emergency room visits.  Examples of the types programs include the following:

  • Expanding patient access to urgent care centers, after-hours care, and nurse help lines give patients safe alternatives to emergency rooms for non-emergency care.
  • Arranging for phone calls and, in some cases, in-home visits by nurses and other professionals to make sure that follow-up appointments are kept, medications are being taken safely, care plans are being followed, medical equipment is delivered, and home health care is being received.
  • Offering intensive case management to help patients at high risk of hospitalization access the medical, behavioral health, and social services they need.
  • Arranging for home visits by multidisciplinary teams of clinicians, who provide comprehensive care, teach patients and their caregivers how to take medications correctly, and link families with needed community resources.
  • Revamping physician payment incentives to promote care coordination and improved health outcomes.

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