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 New Study Links MA Plans to Lower Levels of Hospital Visits

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

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