At a time a growing number of long
term and post-acute care providers are either entering or considering entering
the Medicare Advantage (MA) market on the risk side, a new report by
consultants Avalere Health said their research shows MA beneficiaries spent
less time seeking hospital care for certain conditions.
The report said MA plan holders with
hypertension, hyperlipidemia, and diabetes experienced significantly fewer
inpatient stays and emergency room visits relative to those in traditional
fee-for-service (FFS) Medicare.
Avalere said MA beneficiaries also
outperformed FFS Medicare on key quality measures, such as higher rates of
preventive screenings and tests. Among clinically complex and
dual-eligible/low-income subsidy beneficiaries, health outcomes and cost
savings were significantly better for beneficiaries in MA than those in FFS
Medicare.
“MA beneficiaries with chronic
conditions experienced better quality of care than similar FFS Medicare
beneficiaries,” said Dan Mendelson, founder of Avalere. “Our findings present
new evidence for MA’s value proposition, especially for high-need
beneficiaries.”
Currently, more than one-third of
Medicare beneficiaries are covered by MA plans, a level of use that is
projected to rise sharply in the coming years.
In the study, Avalere said MA
beneficiaries had 23 percent fewer inpatient stays and 33 percent fewer
emergency room visits than FFS Medicare beneficiaries. MA beneficiaries
received more preventive physician tests and services, while FFS Medicare
beneficiaries had more inpatient stays and outpatient/emergency care services.
At least part of the reason for this
is that MA plans focus on preventive care, which may help avoid future utilization
of high-cost services driven by acute-care and emergency needs, according to Christie
Teigland, PhD, vice president at Avalere.
Of the three chronic conditions,
hypertension, hyperlipidemia, and diabetes, the diabetes cohort was the most
complex, with more than 75 percent of MA and FFS Medicare diabetes patients
having all three chronic conditions if they had diabetes. They were referred to
as the clinically complex diabetes cohort.
In Avalere’s study, MA outperformed
FFS Medicare on caring for the clinically complex diabetes cohort. MA
beneficiaries in this cohort had significantly lower rates of complications
from diabetes, including serious complications. And, among dual-eligible
beneficiaries, who receive benefits from Medicare and Medicaid, the analysis
found MA outperformed FFS Medicare on utilization, cost, and quality.
“Dual-eligible MA beneficiaries saw
their primary care providers more frequently and had 33 percent fewer
hospitalizations and 42 percent fewer emergency room visits than those in FFS Medicare,”
the study said.
“At the same time, MA dual-eligible
beneficiaries had lower health care costs relative to those in FFS. Total cost
of care for FFS dual-eligible beneficiaries was 20 percent higher than those in
MA, due to higher inpatient and outpatient utilization in FFS.”
See the full report at
www.avalere.com.