Optum study: Accountable Medicare Advantage models reduce admissions, ER visits

Medicare Advantage patients treated in value-based care models saw better outcomes than those treated in fee-for-service models, according to a new study.

Researchers led by a team at Optum examined claims data on nearly 5.3 million person-years from 2016-19 across 20 different measurements and found that patients in accountable care models were 9% less likely to be admitted to the hospital and 9% less likely to visit the emergency department.

The study found that value-based patients were also 22% less likely to be admitted to the hospital for concerns related to chronic conditions like chronic obstructive pulmonary disorder or asthma, including an 18% reduction in admissions related to hypertension.

In addition, patients treated in value-based models were 9% less likely to be admitted to the hospital from the emergency room, the study found.

The study is the second Optum-led analysis on this topic, following a 2022 analysis on patients treated by Optum providers. The latest analysis includes more than 15,000 primary care physicians and data from 35 health plans, significantly broadening the scope of the research.

Ken Cohen, M.D., the study's lead author and executive director of translational research for Optum Care, told Fierce Healthcare the two studies aren't fundamentally that different but there where some who were skeptical of the results given that they came from Optum with their own physicians.

"So we really thought it was important to get a very broad representation of the healthcare system—broad geography, multiple health plans—and really be able to demonstrate that this isn't unique to a single health plan or a single physician group," he said. "It is unique to value-based care."

Beyond the results around admissions, the study found that the value-based care patients were 15% less likely to use high-risk medications that can cause severe adverse effects, including death, if taken incorrectly or in combination with other medications.

Cohen said the industry has been pushing toward value-based care for decades, but progress has been slow given how entrenched traditional fee-for-service models are in the healthcare system. Optum's healthcare services are built on a foundation of value-based care, so the team is dedicated to playing a key role in driving that shift, he said.

"So what we're hoping is that the results of this study will be one more piece of ammunition that can help propel the care model towards value," Cohen said. "Value-based care is the foundational care model of Optum. We're all-in, and we believe this should be the future of the healthcare."