Value-based models in Medicare Advantage (MA) achieve better patient outcomes and more efficient care compared to traditional Medicare, according to a recent study from Optum.
The study, which was published in JAMA Network Open, included data on more than 316,000 people, split evenly between MA members in a two-sided risk accountable care model and traditional Medicare beneficiaries. The researchers found that the MA model produced better outcomes and greater efficiency across all eight metrics studied, including admissions for certain diseases, avoidable emergency department visits and readmissions.
Patients enrolled in the MA model were 18% less likely to be admitted to the hospital and had 11% lower odds of visiting the emergency room, according to the study. They were 44% less likely to be admitted for complications related to chronic obstructive pulmonary disorder and had a 9% lower rate of 30-day readmissions.
Kenneth Cohen, M.D., executive director of translational research at Optum Health and one of the study's authors, said that the "ideal" health system would pay for high-value services, operate with simple clinical decision support and have a strong basis in evidence.
"I think today fully accountable MA more closely approximates that vision more than any other care model," Cohen told Fierce Healthcare.
Other studies have examined value-based care in MA, but this analysis is the first to compare fully accountable MA to fee-for-service Medicare, something that is "fundamentally different" about these findings.
The study said the improved outcomes identified likely tie back to the care management infrastructure in place in a value-based model, which is informed by the shared risk in the payment structure. For example, these models use telephonic triage for urgent care visits and point-of-care technology within the electronic health record to streamline processes, the research said.
Cohen offered an example of the model at work. For patients with back pain, spinal fusion is a common procedure, performed four times more often in hospitals than spinal decompression therapy, a simpler option. Spinal fusion is the most lucrative procedure to performance in a fee-for-service model, so the incentives are there for providers to continue doing so.
However, Optum created a model that pairs a patient with an expert in rehabilitation who can work with them on alternatives and clearly lay out the risks in getting a surgery they may not need, he said.
"When you use that approach, patients understand it," he said, "and not only do they clinically improve but they make the decision on their own."
He said that accountable care models also have greater incentive to embrace new technologies that may be less expensive than traditional approaches to care.
One of the key hurdles that remains to wider adoption of value-based care is the best way to get providers on board as well as how to convince them to take on greater risk. Cohen said he views three main elements in that strategy. One, solutions must be deployed at the point of care; if a tool is difficult or time-consuming to use, providers will be far less willing to adopt it.
In addition, backing new models with evidence-based education makes the pitch easier. Finally, having granular data to truly prove the point will help build a comprehensive case to them, Cohen said.
"If you can distill it and present it in easily actionable, bite-sized nuggets, then physicians will readily adopt it," Cohen said.