New research offers insight into how high-need, high-cost beneficiaries in Medicare and Medicare Advantage fare on a broad range of quality measures, including pneumonia and flu vaccines to diabetic eye exams, post-acute care, and avoidable hospitalizations.
The report, conducted by Avalere Health and released by the Better Medicare Alliance’s Center for Innovation in Medicare Advantage, examined data on more than 1.4 million Medicare Advantage beneficiaries and 7.9 million traditional Medicare beneficiaries to assess whether care management in Medicare Advantage has an impact on performance in utilization, outcomes, and cost for high-need, high-cost beneficiaries. The study populations included those under 65 years old who are in Medicare due to a disability, the frail elderly, and those with major complex chronic conditions.
The main takeaway: Medicare Advantage achieves better outcomes for high-need, high-cost beneficiaries. Indeed, despite greater social risk factors, the study found these members receive more outpatient visits and more preventive screenings while seeing more appropriate use of prescription drugs and less unnecessary hospitalizations.
“Our report provides meaningful evidence that Medicare Advantage’s use of care management and focus on prevention, outpatient visits, and primary care is making a real difference in the lives of the most vulnerable seniors and under age 65 disabled beneficiaries,” said Allyson Y. Schwartz, president and CEO of the Better Medicare Alliance, in the study announcement.
Here are 10 findings from the report:
- Across the board, Medicare Advantage achieved 15 percent lower combined medical and prescription drug costs compared to traditional fee-for-service (FFS) Medicare.
- Eighty-six percent of the under age 65 disabled beneficiaries received a depression screening compared to 67 percent of similar beneficiaries in traditional FFS Medicare.
- Medicare Advantage beneficiaries received a pneumonia vaccine 49 percent more often than those in traditional FFS Medicare and received a flu vaccine 11 percent more often than those in traditional FFS Medicare.
- Medicare Advantage beneficiaries with major complex chronic conditions had a 57 percent lower rate of avoidable hospitalizations for acute conditions than those in traditional FFS Medicare. Frail elderly beneficiaries had 45 percent lower rates of avoidable hospitalizations for acute conditions.
- Costs for primary care services and tests are 41 percent higher for major complex chronic beneficiaries in Medicare Advantage than those in traditional Medicare, suggesting higher utilization of primary care services.
- Among the under age 65 disabled beneficiaries with diabetes, 79 percent of beneficiaries in Medicare Advantage received an eye exam–used to detect conditions such as diabetic retinopathy–as compared to 51 percent in traditional Medicare.
- Frail elderly beneficiaries in Medicare Advantage had a 66 percent higher rate of outpatient visits as compared to similar beneficiaries in traditional Medicare, showing greater use of lower-cost sites of care.
- Those under age 65 disabled beneficiaries in Medicare Advantage saw 46 percent higher rates of outpatient visits than those in traditional Medicare.
- Overall, beneficiaries in Medicare Advantage had 30 percent lower rates of being concurrently prescribed opioids and benzodiazepines.
- Prescription drug costs were 41 percent lower in Medicare Advantage than traditional Medicare.
During a recent webinar that reviewed the findings, Schwartz said that the report will be key to Better Medicare Alliance’s advocacy work in the coming year because it provides evidence that Medicare Advantage’s use of care management and focus on prevention, outpatient visits, and primary care is making a real difference in beneficiaries’ lives.
“It’s our hope that these findings demonstrate to policymakers and to all of you that achieving better outcomes at a better cost is not only possible but is happening today in Medicare Advantage for millions of Medicare beneficiaries,” she said.