MA enrollees see fewer inpatient stays, ER visits than those in traditional Medicare: report

Medicare Advantage beneficiaries have fewer inpatient hospital stays and emergency department visits than beneficiaries in traditional fee-for-service Medicare, according to a report (PDF) by consulting company Avalere Health.

In addition, MA beneficiaries have fewer chronic conditions, according to the analysis.

The report looks at hypertension, hyperlipidemia and diabetes and compares the two populations in terms of clinical problems, utilization, spending and outcomes related to those conditions. Researchers found that MA serves a higher population of individuals with clinical and social risk factors, and more racial or ethnic minorities (28.1% in MA; 12.8% in FFS).

“The study’s finding of a larger share of racial and ethnic minorities in MA with at least one of the three conditions is consistent with research that has found large increases in enrollment in MA among beneficiaries who identify as racial and ethnic minorities,” the report states.

Regardless of the condition, MA enrollees with chronic conditions spend less on healthcare than people enrolled in traditional Medicare. The report also found that MA beneficiaries with any of the three conditions had more physician office visits and fewer hospitalizations than FFS beneficiaries.

In addition, MA beneficiaries visited EDs less, with a range between 442 and 511 visits per 1,000 people when broken down by specific chronic conditions. Traditional Medicare beneficiaries, meanwhile, had a range of 573 to 665 visits per 1,000 people for the same conditions.

“Total spending was consistently higher among FFS beneficiaries, across all subgroups,” the report said. For example, per member per month spending in MA ranged from $1,532 for diabetic patients to $1,276 for people with hyperlipidemia. By comparison, spending in traditional Medicare was $2,204 to $1,834, respectively.

The report notes the tremendous growth of MA in the last decade, which has expanded from just over one-quarter of Medicare beneficiaries in 2012 to nearly half in 2020. MA is expected to account for 60% of Medicare beneficiaries by 2032.

“Given the substantial growth in MA enrollment over the past decade, policymakers and other stakeholders have a shared interest in comparing trends in care delivery, outcomes, and beneficiary characteristics between [fee-for-service] Medicare and Medicare Advantage,” the report states.

Avalere researchers, in collaboration with researchers with healthcare technology company Inovalon, reviewed data from two sources: 100% of Medicare data via a use agreement with the Centers for Medicare & Medicaid Services, and Inovalon data that comprise information on about 20% of MA beneficiaries in the U.S. Researchers then cross-referenced the data with other Medicare information about dual eligibility, demographic characteristics and the original reason for obtaining the entitlement.

Black and Hispanic patients made up a larger swath of dually eligible members in MA compared to traditional Medicare. 

Dual eligibles in MA were more likely eligible for the program due to age rather than disability compared to traditional Medicare beneficiaries (53.8% versus 46.0%), and fewer dual eligible MA beneficiaries were under age 65 than in FFS (29.5% versus 35.7%).

Among MA beneficiaries, 17.3% had hypertension only, 10.2% had hyperlipidemia only and 2.1% had diabetes only. The breakdown for FFS members: 20.5% had hypertension only, 10.4% had hyperlipidemia only and 2.8% had diabetes only. A majority in both populations had two or more of the conditions: 70.4% in MA and 66.3% in FFS.

“Most frequently beneficiaries had both hypertension and hyperlipidemia (32.8% in MA and 33.8% in FFS),” the study said. “A larger portion in the MA population had all 3 conditions (28.8%) as compared to the FFS population (23.7%).”

More beneficiaries in both FFS and MA were female than male in all the conditions, and traditional Medicare beneficiaries were slightly older than MA beneficiaries.