Medicare Advantage beneficiaries have fewer preventable hospitalizations

Medicare Advantage beneficiaries experience fewer avoidable hospitalizations than those enrolled in traditional fee-for-service Medicare plans, suggesting that MA plans may be more effective at coordinating preventive care, according to a new study.

The study, conducted by the Robert Graham Center for Policy Studies in Family Medicine and Primary Care, on behalf of the Better Medicare Alliance, analyzed hospitalization rates among the different types of Medicare enrollees in 12 states using data from the Healthcare Cost and Utilization Project.

When comparing avoidable hospitalization rates of MA enrollees and traditional Medicare (TM) beneficiaries to the rates of hospitalization for conditions that were not preventable by ambulatory care--and controlling for factors such as gender, race, region and various health proxies--the study found that MA enrollees are 10 percent less likely than TM beneficiaries to have avoidable hospitalizations.

MA enrollees also were approximately 6 percent more likely to experience referral-sensitive hospitalizations, which the study says is a considered a marker for better outpatient care. The findings, though, vary considerably across the states studied, the researchers note.

Further research will likely be needed to determine if the researchers' findings are the result of payment incentives that promote efficiency, coordination and primary care when treating MA enrollees, the study says.

But the results add to past research about Medicare Advantage that suggest "there is more flexibility in that program to get away from the perils of fee-for-service medicine and to really give the patient population an opportunity to have a greater breadth and depth of the primary care experience," Robert Graham Center Director and head researcher Andrew Bazemore, M.D. (pictured) tells FierceHealthPayer in an exclusive interview.

Enrollment in Medicare Advantage plans has risen in recent years, making the business line an especially lucrative one for insurers and encouraging them to improve care quality in order to earn government bonuses. The healthcare industry at large also had made preventing avoidable hospitalization a priority, and a report this past May showed that the rates have dropped among American seniors.

Bazemore's study also found a "spillover effect" in areas with greater MA market penetration, as these areas had lower avoidable hospitalization rates and higher referral-sensitive hospitalization rates among both TM and MA beneficiaries.

That was a particularly important finding, Bazemore says, because he knows first-hand that physician practices need to reach a "tipping point" in which multiple payers embrace innovative payment models in order to be able to fully transition from fee-for-service.

"If you reach a certain threshold and start to see greater concentration of this type of payer in a community or an environment, you're going to have a greater chance that it's going to have a downstream impact across all the patients that a doctor sees," Bazemore says.

The considerable variation across the 12 states also was telling, he adds, given that there seems to be a "Medicare Advantage effect" on preventable hospitalizations but also regional differences that merit more investigation.

"In this time of insurance expansion, we desperately need more comparative studies of how different payment schemes influence delivery systems to impact the outcomes we care about," he says. "This is the time to do it because we are ramping up on the number of folks that are covered by insurance generally, and it's really important to understand where our best quality, best cost scenarios intersect."

To learn more:
- here's the study

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