The secret of Medicare Advantage’s success with outcomes: Consistent care coordination

Medicare Advantage covers a disproportionate share of disadvantaged senior citizens compared with traditional fee-for-service Medicare, yet the former bests the latter on some key outcomes metrics.

The divergence is particularly pronounced when the relevant data is analyzed with rigorous adjustments for baseline differences between the two subpopulations.

Important among the differences are enrollment patterns and disadvantage indicators common to Advantage enrollees, including pre-existing demographic, clinical and social risk factors.

After adjustments for these factors, Advantage beneficiaries evidence a hospital readmission rate some 70% lower than their fee-for-service peers.

Advantage members also have 35% fewer preventable inpatient admissions, lower rates of inappropriate medication use and comparable rates of medication adherence.

The findings are from research conducted by policy researchers at Harvard Medical School and the American Enterprise Institute in collaboration with research colleagues at the healthcare cloud supplier Inovalon.

The findings are published in a report posted online by Inovalon.

Medicare Fee-for-Service falling behind Advantage’s advantages

Christie Teigland, PhD, and colleagues used Inovalon data to track patients’ quality-of-care outcomes before the patients turned 65 and had commercial coverage, then compared this data with post-65 outcomes when they were covered by either Medicare Advantage or traditional Medicare.

Inovalon says its data draws from 30% of all privately insured lives and 100% of public Medicare lives at any given point in time.

For the present study, the analysts used a sample data subset comprising more than 50,000 fee-for-service Medicare patients and more than 10,000 individuals who enrolled in Advantage at age 65.

Other key findings in the report:

• Medicare Fee-for-Service (FFS) has 3.6 times higher rates of 30-day readmissions compared to Medicare Advantage. It also has 1.6 times higher rates of potentially avoidable hospitalizations overall, with 2.5 times higher rates for acute conditions and 1.3 times higher rates for chronic conditions.
• Rates of inappropriate use of high-risk medications are 1.6 times higher in FFS before matching and remain 1.4 times higher after controlling for patient characteristics.
• Medicare Advantage has 24% fewer preventable hospitalizations relative to FFS. The reduction is especially concentrated among preventable acute-related hospitalizations, “for which we see a 59% reduction, which is highly statistically significant,” the authors remark.
• Preventable chronic hospitalizations are 8.6% lower under Medicare Advantage. “We additionally find 70% fewer 30-day all-cause readmissions, after adjusting for any differences that existed prior to Medicare enrollment, a result which is also highly statistically significant,” the authors write.
• High-risk medication use is 21% lower among Advantage enrollees, “a substantial difference that is also highly statistically significant.”

Attention to the numbers must be paid, the authors suggest, as Medicare Advantage now covers more than half of Medicare beneficiaries.

Better care coordination—not worse care access—is the key utilization cutter

In their discussion section, Teigland and co-authors state the study offers policymakers new perspective on the quality improvements that Medicare Advantage delivers for beneficiaries as compared with Medicare Fee-for-Service.

Suggesting that overall utilization reductions under Advantage tend to reflect better care quality rather than compromised care access, they comment:

“The study underscores the role that care management and coordination can play in promoting quality within the Medicare program. Furthermore, the study indicates that the lack of care management in Medicare’s fee-for-service program has negative ramifications for beneficiaries, and that recent reforms to [fee-for-service Medicare]—such as the introduction of accountable care organizations and value-based initiatives—have clearly not brought sufficient care management to the fee-for-service program.”

The report is available in full for free.