Seniors enrolled in private Medicare Advantage plans had one-third fewer emergency room visits and 23% fewer stays in a hospital than those enrolled in traditional fee-for-service Medicare, a new study by health research firm Avalere Health shows.
The 32-page report, funded by the insurance industry-backed Better Medicare Alliance, comes as the Trump administration expands the services private health plans can offer seniors via Medicare Advantage plans. These MA plans contract with the federal government to provide extra benefits and services to seniors than traditional Medicare, such as disease management and nurse help hotlines, with some also providing vision and dental care and wellness programs.
The Better Medicare Alliance’s new study documents how Medicare Advantage plans thus far have guided seniors to lower cost services and coordinated care to keep them out of the hospital and emergency room. The study, which Avalere researchers said they controlled editorially, looked at 1.5 million MA beneficiaries and 1.2 million fee-for-service Medicare beneficiaries with chronic conditions like high blood pressure, high cholesterol and diabetes.
“Utilization of costly healthcare services was lower for Medicare Advantage beneficiaries, including 23% fewer inpatient stays (249 versus 324 per 1,000 beneficiaries in fee-for-service Medicare) and 33% fewer emergency room visits (511 versus 759 per 1,000 beneficiaries in fee-for-service Medicare),” the Avalere report said.
Avalere researchers say the study documents how MA plans are better at encouraging seniors to see primary care doctors. Thus, seniors in MA plans have “higher rates of screening and tests,” researchers said in a statement accompanying the Avalere study. “Medicare Advantage plans’ focus on preventive care may help avoid downstream utilization of high-cost services driven by acute-care and emergency needs,” said Christie Teigland, vice president at Avalere.
MA plans may soon offer even more benefits. The Centers for Medicare & Medicaid Services (CMS) earlier this year finalized new policies, “reinterpreting the standards for health-related supplemental benefits” in the MA program to include additional services “that increase health and improve quality of life, including coverage of non-skilled in-home supports and other assistive devices.”
While health plans like Aetna, UnitedHealth Group, Humana and SCAN Health that are part of the Alliance get bids ready to offer seniors more benefits in 2019, they want to show MA plans are working to get elderly Medicare beneficiaries the right care, in the right place and at the right time.
Currently, just under 35% of Medicare beneficiaries, or about 20 million Americans, are enrolled in MA plans. But Medicare Advantage enrollment is projected to rise to 38 million, or 50% market penetration by the end of 2025 , L.E.K. Consulting projects, in part due to the additional benefits MA plans will be offering in the future.
“Medicare Advantage incentivizes plans to provide more coordinated care and preventive services, enabling high-need beneficiaries to avoid costly complications and hospitalizations,” Avalere vice president Sean Creighton said in a statement accompanying the study.
Original article written by Bruce Japsen and posted on Forbes.com