Medicare Advantage yields better health outcomes than fee-for-service
More Medicare beneficiaries are opting into Medicare Advantage (MA) every year, and their health outcomes might be better than those in traditional fee-for-service (FFS).
Medicare Advantage patients with chronic illnesses experienced fewer inpatient stays and emergency room visits compared to traditional fee-for-service Medicare patients, according to a recent report from Avalere Health.
Overall, clinically complex and dual-eligible/low-income subsidy beneficiaries had better health outcomes and lower costs in MA. Avalere compared the metrics of MA and FFS beneficiaries with one or more of three chronic conditions–hypertension, hyperlipidemia and diabetes.
The findings underscore the growing value proposition for Medicare Advantage, which provides Medicare beneficiaries coverage through private insurers contracted with CMS.
MA plans have been growing in popularity over the last few years and currently cover more than one-third of all Medicare enrollees, or 19 million people. Since the passage of the Affordable Care Act in 2010, MA enrollment has jumped 71 percent, according to the Kaiser Family Foundation.
MA beneficiaries received higher quality of care, with more preventive physician tests and services compared to their FFS Medicare counterparts in Avalere’s study. MA beneficiaries had 23 percent fewer inpatient stays and 33 percent fewer emergency room visits than FFS beneficiaries.
“Medicare Advantage plans’ focus on preventive care may help avoid downstream utilization of high-cost services driven by acute-care and emergency needs,” Christie Teigland, PhD, vice president at Avalere, said in the report.
Among diabetes patients, MA outperformed FFS, with significantly lower rates of complications from the disease, including serious complications, among MA beneficiaries. This cohort was more likely to be complex, with 75 percent of MA and FFS diabetes patients having all three chronic conditions.
Dual-eligible patients, who qualify for both Medicare and Medicaid benefits, also fared better on MA than traditional FFS Medicare, with 33 percent fewer hospitalizations and 42 percent fewer emergency room visits. MA dual eligibles also saw their primary care providers more frequently but still had lower healthcare costs compared to FFS beneficiaries by 20 percent.
“Medicare Advantage incentivizes plans to provide more coordinated care and preventive services, enabling high-need beneficiaries to avoid costly complications and hospitalizations,” Sean Creighton, vice president at Avalere, said in the report.
Amy joined TriMed Media as a Senior Writer for HealthExec after covering home care for three years. When not writing about all things healthcare, she fulfills her lifelong dream of becoming a pirate by sailing in regattas and enjoying rum. Fun fact: she sailed 333 miles across Lake Michigan in the Chicago Yacht Club "Race to Mackinac."