Medicare Advantage plans achieve better outcomes than traditional Medicare, BMA analysis finds

Medicare Advantage (MA) outperforms traditional Medicare on several quality measures such as preventive screenings and avoiding hospitalizations, a new report finds.

The report released Wednesday and funded by the Better Medicare Alliance, a Medicare Advantage advocacy group, explores healthcare use, outcomes and costs between MA and traditional Medicare.

“Medicare Advantage beneficiaries had 49% and 11% higher rates of vaccination for pneumonia and the flu and the contrasts are even more pronounced among high-need, high-cost beneficiaries,” said Allyson Schwartz, president and CEO of the Better Medicare Alliance. “For example, beneficiaries with major complex chronic conditions had 57% lower rate of avoidable hospitalizations for acute conditions in Medicare Advantage than in traditional Medicare.”

Medicare Advantage also scored higher on clinical visits 14 days after a hospital discharge, with 74% of frail and elderly MA participants having such a visit compared to 52% of traditional Medicare beneficiaries in the same category.

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The study conducted by the consulting firm Avalere Health looked at MA encounter data and a sample of Medicare Parts A and B claims data as well as Part D drug event data from 2015 through 2017. The study population was 1.4 million MA beneficiaries and 7.9 million traditional Medicare beneficiaries.

Other key findings of the report include:

  • Better rates of eye exams for diabetics that are 14 to 56% higher in MA compared with traditional Medicare.
  • 66% more MA frail elderly beneficiaries get outpatient visits.
  • Rates for depression screenings were 18 to 27% higher for MA beneficiaries and rates of pneumonia vaccinations were 50 to 52% higher.
  • Inpatient hospital costs were nine to 23% lower among high-need, high-cost populations in MA relative to fee-for-service Medicare.
  • Part D drug costs were 38 to 44% lower.

The report links the better results to key features of the MA program such as risk-adjusted capitation payments and strong value-based care performance incentives to “enable plans to offer care management interventions that help meet the complex care needs of vulnerable beneficiaries in ways that achieve positive health outcomes.”

The MA plans also have an incentive to encourage more preventive services and care management to increase plan efficiency, the report said.

Of the more than 24 million beneficiaries in MA, 21.6 million are enrolled in a plan that integrates Medicare’s inpatient and outpatient services with prescription drug benefits.

The report comes as enrollment in MA is expected to surge to 42% of all beneficiaries as of 2028, according to a report from the nonpartisan Congressional Budget Office.