New Data Follow Prior AHIP Research Demonstrating the Higher-Quality Care Medicare Advantage Plans Provide
A recent article in the latest edition of Health Affairs provides further evidence that Medicare Advantage plans are delivering higher-quality care to seniors and people with disabilities than the fee-for-service (FFS) part of Medicare. Data from the article show that Medicare Advantage beneficiaries utilize some health care services, such as the emergency department and ambulatory surgery or procedures, at a rate 20-30 percent lower than those in FFS Medicare. This data suggests that Medicare Advantage enrollees “might use fewer services and be experiencing more appropriate use of services than enrollees in traditional Medicare.”
The article follows prior research from AHIP’s Center for Policy and Research showing that seniors and people with disabilities enrolled in a Medicare Advantage plan have significantly fewer hospital admissions and readmissions than those enrolled in the original Medicare program.
Key findings from the Health Affairs article include:
- “Relative to traditional Medicare, Medicare Advantage HMOs may be able to treat a given patient with greater efficiency while attaining equal or superior quality through their flexibility in enrollee benefits, network contracting, and coordination of care.”
- “Health plans may actively manage the provider networks through which they deliver care and employ programs to promote the delivery of appropriate services and avoid excessive utilization. In addition, plans use a variety of financial incentives to physicians to influence the quality and quantity of services delivered. These are all hallmarks of integrated care. In contrast, in traditional Medicare, physicians make clinical decisions for their patients with little or no oversight.”
- “Emergency department visits were about 25–35 percent lower in Medicare Advantage HMOs, and this difference was relatively stable across the study period.”
- “Inpatient medical days were about 20–25 percent lower in Medicare Advantage HMOs throughout the time period.”
- “Use of coronary artery bypass graft surgery was consistently higher for Medicare Advantage HMO enrollees regardless of period of plan entry…”
- “Rates of elective knee replacements were approximately 10 percent lower in Medicare Advantage HMOs for existing plans and were closer to 20 percent lower for new entrants….Rates of elective hip replacement showed similar patterns…”
- “…rates of reduction (that is, repair) of femur fractures—a nondiscretionary procedure that might be an indicator of population frailty—were higher in Medicare Advantage HMOs than in traditional Medicare…”
- “Use of some services such as hip and knee replacement was also lower in Medicare Advantage HMOs, but coronary bypass surgery was more common.”
- “…relative to beneficiaries in traditional Medicare, Medicare Advantage HMO enrollees are more commonly treated with cardiac bypass surgery, in accord with current guidelines.”
- “…lower rates of emergency department use suggest that Medicare Advantage HMOs may be treating patients in less costly primary care or urgent care settings.”
- “…the integrated approach used by Medicare Advantage HMO plans appears to be successfully controlling the use of the most discretionary services, such as hip and knee replacement and outpatient surgery or procedures, while maintaining the use of nondiscretionary services such as the reduction of femur fractures.”
Research Shows that Medicare Advantage Plans have Lower Hospital Readmission Rates than FFS Medicare
The findings from the Health Affairs article are consistent with prior AHIP research showing that Medicare Advantage plans are delivering high-quality care and helping to address critical issues in the delivery system, including reducing preventable hospital readmissions, increasing primary care visits, and managing chronic illnesses.
- According to a study published in the American Journal of Managed Care (AJMC), unadjusted 30-day readmission rates for Medicare Advantage 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 Medicare Advantage 30-day readmission rates to be 13% to 20% lower than traditional Medicare FFS rates.
- According to a separate study in Health Affairs, people with diabetes in a special-needs plan had seven percent more physician office visits; nine percent lower hospital admission rates; 19 percent fewer hospital days; and 28 percent lower hospital readmission rates compared to patients in FFS Medicare.
- A study analyzing data from nine states found reductions in risk-adjusted hospital readmission rates averaging 14-29 percent among seniors in Medicare Advantage compared with Medicare FFS enrollees.
ACA’s Funding Cuts and Health Insurance Tax will Harm Medicare Advantage Beneficiaries
The Affordable Care Act (ACA) cuts more than $200 billion from the Medicare Advantage program and imposes a new health insurance tax that will put at risk the benefits and coverage ten million seniors and people with disabilities rely on today.
Click here to learn more about the impact these cuts will have on Medicare Advantage beneficiaries.