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Medicare Advantage outperforms traditional Medicare for chronically ill, report shows

The program outperforms the fee-for-service version when it comes to higher rates of preventive screenings, fewer avoidable hospitalizations.

Jeff Lagasse, Associate Editor

Patients with certain chronic conditions enrolled in Medicare Advantage -- the managed-care option in Medicare -- experience better health outcomes and similar or lower costs compared to those enrolled in traditional fee-for-service Medicare, according to a new report from Avalere Health.

Specifically, the findings show hospital executives that Medicare Advantage outperforms traditional Medicare when it comes to higher rates of preventive screenings, fewer avoidable hospitalizations and fewer emergency room visits.

This provides evidence that Medicare Advantage has the ability to align incentives to better manage a high-need population with multiple chronic conditions -- which should be brought to the attention of policymakers, the authors said. Due to its performance in these areas, it would do well to keep Medicare Advantage a viable option for beneficiaries, particularly those with multiple chronic conditions.

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Avalere compared demographic, clinical, utilization, quality and cost metrics of Medicare Advantage and FFS Medicare beneficiaries with one or more of three chronic conditions: hypertension, hyperlipidemia and diabetes. 

Medicare Advantage beneficiaries in Avalere's study had 23 percent fewer inpatient stays and 33 percent fewer emergency room visits than FFS Medicare beneficiaries. Medicare Advantage beneficiaries also received more preventive physician tests and services, while FFS Medicare beneficiaries had more inpatient stays and outpatient/emergency care services.

While the Medicare Advantage and FFS Medicare study populations had similar demographic profiles, Medicare Advantage had a higher proportion of beneficiaries with clinical and social risk factors shown to affect outcomes and cost than FFS Medicare. About 64 percent of Medicare Advantage beneficiaries had a higher likelihood of enrolling in Medicare due to disability, for instance, and 57 percent had a higher rate of serious mental illness. They also had a 16 percent higher rate of drug and substance abuse.

Yet despite a higher proportion of risk factors, Medicare Advantage beneficiaries with chronic conditions experienced lower utilization of high-cost services, higher rates of preventive tests and screenings and better outcomes. In fact, they had 23 percent fewer inpatient hospital stays, 33 percent fewer emergency room visits, a 29 percent lower rate of potentially avoidable hospitalizations, and a five percent higher rate of breast cancer screening.

The Centers for Medicare and Medicaid Services released Medicare Advantage data for the first time in April, providing detailed information about services to beneficiaries. The goal was to give researchers insight into the care delivered under MA plans and help them improve the Medicare program, CMS said.

Twitter: @JELagasse
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