A new paper by Ken Thorpe says that Medicare Advantage prevention and care coordination approaches can be used to reform original Medicare.
According to the paper, “the best-known lifestyle modification program is the Diabetes Prevention Program (DPP).” The DPP, which aims to prevent type 2 diabetes in individuals who have prediabetes, has had great success, including a large scale trial that found that lifestyle intervention reduced the prevalence of diabetes by 58 percent relative to placebo. “Some private sector health plans…have contracted with the Y to provide the DPP intervention to at-risk adults.” AHIP and four member health plans have partnered with the CDC to implement the DPP in Florida, New Mexico, New York, and Texas. The health plans will collect data from the intervention sites, and AHIP will compile the data and report outcomes to the CDC as well as promote the program to health plans and employers.
Thorpe also explores the success of care coordination in Medicare Advantage plans saying, “Despite the fact that most of the spending in traditional Medicare is associated with chronically ill patients, the program currently provides no care coordination. This contrasts sharply with the Medicare Advantage program where health plans routinely provide care coordination.” Thanks to care coordination and other practices, research has shown that hospital readmissions rates are lower in Medicare Advantage plans than in traditional Medicare. Thorpe cites an AHIP study published in the American Journal of Managed Care, saying “These results are similar to those estimated by Lemieux and colleagues. After adjusting for risk of admission, they found that 30 day readmission rates for Medicare Advantage patients overall were approximately 13 to 20 percent lower than similar patients in traditional Medicare.” Preventing avoidable hospital admission and protecting patients from the risks associated with inpatient settings, such as infection, are indications that patients are getting the care and services they need on an outpatient basis to stay healthy and avoid complications that can lead to hospital readmissions.
More information on the value health plans are providing to Medicare Advantage beneficiaries:
- AHIP’s Innovations in Reducing Preventable Hospital Admissions, Readmissions and Emergency Room Use
- Testimony for the House Ways and Means Committee Subcommittee on Health: The Medicare Advantage Program and the Role of Private Health Plans in Serving Medicare Beneficiaries