A new study found that Medicare Advantage members experience better quality outcomes than fee-for-service Medicare members, including fewer readmissions, fewer preventable hospitalizations and lower rates of high-risk medication use.
The study was published Wednesday by Harvard Medical School and Inovalon, a provider of cloud-based software solutions. Inovalon’s dataset allows the researchers to track from before patients turned 65 and were covered under commercial insurance to after they turned 65 and enrolled in Medicare. The study relied on a sample of 50,512 individuals enrolled in fee-for-service Medicare and 10,158 individuals enrolled in MA. It adjusted for pre-existing differences between the two populations, such as different demographic, clinical and social risk factors. This is the third report by the researchers comparing differences between MA and FFS Medicare (the first found that MA beneficiaries are more likely to be socioeconomically disadvantaged and the second found lower healthcare utilization among MA beneficiaries).
At ViVE 2024, Panelists Share Prior Authorization Progress and Frustration in Payer Insights Program
At the Payer Insights sessions on Day 1 of ViVE 2024, a panel on prior authorization offered compelling insights from speakers who shared the positive developments in this area after years of mounting frustration. Speakers also shared challenges as they work with providers to figure out how policy developments and technology will work in practice.
The researchers discovered that MA beneficiaries experienced 70% fewer readmissions than fee-for-service Medicare enrollees. In addition, MA enrollees had 24% fewer preventable hospitalizations and 59% fewer preventable acute hospitalizations. The “magnitude” of the quality improvement that MA achieved was surprising, according to Boris Vabson, a health economist at Harvard Medical School and lead researcher of the study.
“[The findings] also confirm that a lot of the overall healthcare utilization reduction that we saw under Medicare Advantage, which we documented in the previous white paper, came through improved health outcomes for patients rather than through restricting or rationing care. Put another way, a key reason why patients appear to be going to the hospital less under Medicare Advantage is because they have fewer complications and don’t need the care, unlike those in FFS,” Vabson said in an email.
Also surprising to Vabson was that there was a 21% lower rate of inappropriate high-risk medication use among MA beneficiaries versus fee-for-service Medicare enrollees. Overall medication use was similar between the two groups.
“This indicates that MA is able to be very targeted in terms of managing and impacting care, for example by reducing use of high-risk medications but not reducing utilization of high-benefit medications,” Vabson stated.
Unlocking Transparency in PBM Pricing
The TSX Venture Exchange has a strong history of helping early-stage health and life sciences companies raise patient capital for research and development.
Why did MA members fare better than their fee-for-service counterparts? The results are likely partially due to the “keen focus on health disparities and health equity in MA,” noted Christie Teigland, vice president of research science and advanced analytics at Inovalon.
“MA plans provide members with social risk factors — such as inadequate housing, lack of transportation, poor access to healthy food, and other factors known to impact health outcomes — with non-medical benefits to address those social needs,” Teigland said in an email. “These benefits are generally not available under FFS.”
Vabson added that MA plans offer more care management and care coordination services than fee-for-service Medicare, and are financially incentivized to deliver more quality care.
In future reports, the researchers will examine how MA tackles health inequities, as well as compare differences between different types of MA plans.
Photo: zimmytws, Getty Images
