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She is senior editor of Managed Healthcare Executive.
Medicare Advantage beneficiaries in California spent 30% fewer days in the hospitals than patients with FFS Medicare
Seniors in Medicare Advantage spent fewer days in a hospital, were subject to fewer hospital readmissions, and were less likely to have “potentially avoidable” admissions, for common conditions ranging from uncontrolled diabetes to dehydration, according to a new analysis of publicly available data released by America’s Health Insurance Plans (AHIP).
Key findings, produced from data from the Agency for Healthcare Quality and Research, include:
• Medicare Advantage beneficiaries in California spent 30% fewer days in the hospitals than patients with FFS Medicare, and in Nevada, seniors in Medicare Advantage plans spent 23% fewer days in the hospital.
• Medicare Advantage enrollees were readmitted to the hospital in the same quarter for the same condition 15% less often in California and 33% less often in Nevada compared with FFS Medicare.
• In California and Nevada, seniors in Medicare Advantage were 6% less likely than seniors in FFS Medicare to be admitted to the hospital for conditions described by AHRQ as “potentially avoidable,” such as dehydration.
“The findings are consistent with earlier studies indicating Medicare Advantage Plans provide an important service to seniors-improved coordination of their care-which affords plan sponsors improved outcomes and lower costs,” says Paul Keckley, PhD, executive director, Deloitte Center for Health Solutions.
“Other studies have also indicated enrollees in these plans are more satisfied than those who use traditional Medicare, so a solid value proposition is evidence in the Medicare Advantage program,” Keckley says.
For Medicare Advantage Plan sponsors, a vigorous effort should be made to reduce proposed cuts to these plans by Medicare-which the White House believes might save $177 billion over 10 years. For all plans, the ability to demonstrate the ROI for improve coordination of care is an absolute necessity as employers shift responsibility to individuals for clinical decisions and costs.
“Long-term, health plans will need to provide a solid value proposition based on outcomes and cost: this study provides a useful framework for that discussion by plans,” Keckley says.
The new analysis follows a previous AHIP study comparing utilization rates among patients in eight Medicare health plans compared to seniors in FFS Medicare. This study among seniors with certain chronic conditions in California and Nevada also found that:
• Medicare Advantage beneficiaries spent an average of 18% fewer days in the hospital than seniors in FFS Medicare.
• Seniors in Medicare Advantage had an average of 27% fewer visits to the emergency room than those seniors in traditional Medicare.
• Seniors enrolled in Medicare Advantage health plans also experienced a 42% lower rate of hospital re-admissions than those seniors in FFS Medicare.
• Avoidable admissions to the hospital were 13% lower among seniors in Medicare Advantage plans than those in traditional Medicare.