Medicare Advantage beats fee-for-service in utilization, outcomes

Medicare Advantage appears to be working wonders on some of America’s most vulnerable—and costly—patients.

Despite higher rates of social and economic risk factors, Medicare Advantage beneficiaries experience 23.1% fewer inpatient stays and 32.7% fewer ER visits than the fee-for-service (FFS) population does, including 28.6% fewer avoidable hospitalizations,  according to a new analysis (PDF) by Avalere, which compared service utilization and health outcomes between MA and FFS beneficiaries.

This trend extended to the dual-eligible subsets of each Medicare population as well. Like MA patients overall, dual-eligibles in MA see fewer complications and avoidable hospitalizations than those in FFS, but they also spend more on preventive services, including LDL tests used to measure cholesterol (81.5% vs. 69.4%) and breast cancer screens (73.1% vs. 50.0%).

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The report homed in what it called the “clinically complex diabetes cohort”—diabetic patients who also have hypertension and hyperlipidemia. While 17.1% of FFS Medicare beneficiaries experienced diabetes-related cellulitis, ulceration, osteomyelitis, gangrene or amputation, only 8.2% of MA beneficiaries did—a 52% difference. Moreover, FFS beneficiaries experienced two or more of those complications at a nearly 75% higher rate than MA beneficiaries.

The American Diabetes Association estimates one-seventh of U.S. healthcare spending goes toward diabetes.

Despite these differences, MA and FFS patients spend comparable amounts per capita and access care at similar rates, implying that MA can keep patients healthier than FFS can.

The report suggests MA plans can better coordinate care for people with chronic conditions, according to Avalere vice president Sean Creighton, who formerly worked at the Centers for Medicare & Medicaid Services. He added that policies that allow MA plans to innovate ways to manage care would best benefit enrollees going forward.

“The more flexibility that Congress gives Medicare Advantage to do that, I think the greater the rewards will be," he said.