July 27, 2018

Research at a Glance: Medicare Advantage Achieves Better Outcomes for Beneficiaries with Chronic Conditions Relative to Traditional Fee-for-Service Medicare

To date, there have been few comprehensive analyses of the outcomes achieved in Medicare Advantage compared to Traditional Fee-for-Service (FFS) Medicare. New research conducted by Avalere is changing that. Researchers found Medicare Advantage beneficiaries with hypertension, hyperlipidemia, and diabetes received more preventive services and physician services, and experienced significantly fewer inpatient hospital stays and emergency room visits relative to FFS Medicare. While the study did not explore causal relationships, the authors suggest that the focus on primary care, preventive services and integrated care management may be the reason Medicare Advantage beneficiaries avoid higher-cost emergency services and inpatient stays more commonly utilized in FFS Medicare.


These findings are significant as policymakers look for ways to improve the quality of care and lower health care costs, particularly for patients managing chronic conditions. In FFS Medicare, over 50% of beneficiaries have at least three chronic conditions. In fact, people with more than 4 or more chronic conditions in Medicare have been estimated to account for as much as 93% of total spending. Analysis of the health care costs and utilization of the most chronically ill beneficiaries in Medicare Advantage showed lower utilization of the costliest health care services while achieving better health outcomes than similar beneficiaries in FFS Medicare.


The findings suggest that the focus on care management in Medicare Advantage may lead to more efficient treatment and patterns of care delivery. The results show that among dually-eligible beneficiaries, who receive benefits from both Medicare and Medicaid, Medicare Advantage outperformed FFS Medicare on utilization and outcomes. Dual-eligible Medicare Advantage beneficiaries saw their physicians more frequently and had 33% fewer hospitalizations and 42% fewer emergency room visits than those in FFS Medicare. Overall, dual-eligible beneficiaries had better outcomes with 17% lower average per beneficiary costs relative to FFS Medicare.


The Avalere study also found that the Medicare Advantage study population had higher rates of preventive screenings. These findings corroborate previous research. For example, one previous study found Medicare Advantage beneficiaries used preventive care at a 20% higher rate than FFS Medicare beneficiaries. Another study found Medicare Advantage beneficiaries received more appropriate diabetes care, cholesterol testing for cardiovascular disease and breast cancer screening.


Boosting primary and preventive care has been widely found to reduce hospitalizations. Driving health care utilization to high-value services has been found to lower spending, with one study finding Medicare Advantage beneficiaries have 20-30% fewer emergency department visits and inpatient hospital stays. Another study looking at value-based care in Medicare Advantage found increased office-based care, and decreased hospital-based services even improve survival rates.


The Avalere study findings show that Medicare Advantage beneficiaries with chronic conditions experience better outcomes, and lower health care utilization, which suggests a better quality of life for beneficiaries with chronic conditions. In our previous blog, the demographic characteristics of chronically ill Medicare Advantage beneficiaries relative to FFS Medicare was analyzed. The next blog in this series will discuss Avalere findings on dual-eligible beneficiaries and the high-value outcomes Medicare Advantage achieved for clinically complex diabetes relative to FFS Medicare.


To better understand how Congress and the Administration can act to protect and strengthen Medicare Advantage, please visit the Better Medicare Alliance policy resource library and sign up for our policy alerts.

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