MA enrollees have fewer hospitalizations, Harvard study finds

Medicare Advantage (MA) beneficiaries have better quality of care and health outcomes than traditional fee-for-service counterparts, researchers from Harvard Medical School found.

The recently released report found that MA enrollees experience 70% fewer readmissions than fee-for-service beneficiaries and 24% fewer preventable hospitalizations, primarily driven by 59% fewer preventable acute hospitalizations.

“The study provides strong evidence that care management and coordination are key to better outcomes,” said Boris Vabson, health economist at Harvard Medical School and co-lead researcher on the project, in a statement. “While recent reforms such as the introduction of accountable care organizations (ACOs) have attempted to improve Medicare care management, our research shows additional steps are needed to improve care coordination and quality of care under fee-for-service Medicare.”

The data also found that there was no statistically meaningful difference between MA and fee-for-service in regard to medication adherence but 21% lower rates of high-risk medication use under MA. The results come from a research collaboration from Inovalon and Harvard Medical School, building on previous studies. Those white papers revealed that traditional Medicare enrollees have more than 50% fewer inpatient hospital stays and 22% fewer emergency department visits and that MA beneficiaries often have less money and face greater environmental challenges than traditional Medicare beneficiaries. More than half of Medicare enrollees in the U.S. are enrolled in MA plans rather than traditional plans.

“We believe this data can help health plans identify opportunities for quality improvement, especially for those in our health system who have been historically underserved and are at higher risk of needing complex care,” said Christie Teigland, Ph.D., vice president of research science and advanced analytics at Inovalon and co-lead researcher on the project, in a statement. “Under the new CMS Health Equity Index framework, it will be imperative for health plans to address socioeconomic disparities to improve 5-Star ratings and qualify for bonus payments. Our research gives them the insights they need to maximize financial incentives and, most importantly, promote health equity and deliver better health outcomes.”

The Centers for Medicare & Medicaid Services’ updated framework will require health plans to provide more equitable care or risk receiving a downgraded star rating.

Inovalon also entered into a partnership with Amazon Web Services in mid-October, which combines the AI and machine learning expertise of both companies. The partnership allows Inovalon to utilize natural language processing technologies to “derive insights from unstructured clinical text and map clinical concepts to standardized medical codes,” a press release said.

“Our focus is on the relentless enhancement of the Inovalon ONE Platform so that we can in turn empower our customers to achieve their missions,” said Eron Kelly, president of Inovalon, in a statement. “This is the first of several collaborations we are doing with AWS to empower our customers to improve healthcare outcomes and economics through the thoughtful and careful use of AI/ML.”