New research from Avalere finds that Medicare Advantage (MA) plans outperformed fee-for-service (FFS) Medicare on overall cost of care, quality measure outcomes, and utilization of high cost health services for the care of dual eligible beneficiaries with chronic conditions.

The study findings come in the wake of a Kaiser Family Foundation report that questioned how much MA plans lower spending. Until now there has been little published information comparing the performance of MA and traditional FFS Medicare. This is due to a lack of access to MA encounter data compared to the FFS data that has been studied extensively, according to Avalere researchers. They presented their findings at the International Society for Pharmacoeconomics and Outcomes Research meeting on May 21.

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Researchers looked at health care utilization, cost, and quality outcomes across two large national samples of dual eligible MA and FFS Medicare beneficiaries who had hypertension, hyper lipidemia, and diabetes, or a combination of these chronic conditions, which are common in the Medicare population. They used a descriptive, cross-sectional cohort design to analyze a sample of more than 1.5 million MA beneficiaries extracted from a proprietary, statistically de-identified registry, and a sample of more than 1.2 million FFS Medicare beneficiaries extracted from Medicare Standard Analytic Files.

Overall key findings

Findings showed that dual eligible MA beneficiaries had significantly lower rates of complications, avoidable hospitalizations and readmissions, and received more preventive care services than dual eligible FFS Medicare beneficiaries.

Key findings: Utilization

Specifically, the study found that compared to dual-eligible FFS Medicare beneficiaries, dual-eligible MA beneficiaries had:

  • 7 percent more office visits
  • 9 percent lower rates of hospitalizations, but similar lengths of stay
  • 1 percent fewer emergency room visits

Key findings: Preventive screenings, tests, and complications

Dual eligible MA beneficiaries:

  • Received more preventive care services than dual eligible FFS Medicare beneficiaries, including a 17.4 percent higher rate of LDL testing
  • Received more preventive breast cancer screenings (73.1 percent had the screenings compared to only half of dual eligible FFS Medicare beneficiaries)
  • Had a 24.1 percent lower rate of potentially avoidable hospitalizations and had about half as many potentially avoidable acute hospitalizations

Dual eligible MA beneficiaries with diabetes:

  • Had significantly lower rates of complications, including 49 percent of fewer complications overall and 71 percent fewer serious complications

However, rates of HbA1c testing were similar for dual eligible beneficiaries in MA and FFS Medicare. Dual eligible FFS Medicare beneficiaries also had 15.1 percent lower rates of readmissions compared to dual eligible MA beneficiaries.

Key findings: Cost of care

Total cost of care for dual eligible beneficiaries was 16.7 percent higher in FFS Medicare compared to the MA population. Researchers noted this was driven by higher spending on hospital inpatient and outpatient services in FFS Medicare. However, MA spent more on physician services and tests.

Despite this, FFS Medicare costs were 9.8 percent lower than MA for non-dual eligible beneficiaries which was driven by lower FFS spending on physician services and tests in MA.


The findings suggest that the flexibility of MA plans to provide additional benefits and coordinate care leads to better outcomes and lower costs for Medicare.

Study authors noted that while the MA and FFS Medicare study population were similar in age and gender, the MA population had a higher proportion of social and clinical risk factors, such as more dual eligible/low income beneficiaries, more beneficiaries who enrolled in Medicare under age 65 due to disability, and higher rates of serious mental illness and alcohol/drug/substance abuse. Furthermore, MA also had larger proportions of racial/ethnic minorities enrolled compared to FFS Medicare.

“These factors have been shown to be associated with greater disease burden, higher needs,

increased spending, and worse outcomes,” the study authors said. “This context is important to consider in interpreting the unadjusted results and findings of this study.  As results were not adjusted to account for the higher prevalence of risk factors in the MA population, these findings may underestimate the performance of MA relative to FFS Medicare.”