Medicare Advantage's preventive health care strategy keeps seniors out of the hospital

Sep 16 2009

Seniors in Medicare Advantage spent fewer days in a hospital, were subject to fewer hospital re-admissions, and were less likely to have "potentially avoidable" admissions, for common conditions ranging from uncontrolled diabetes to dehydration, according to a new analysis of publicly available AHRQ data released today by America's Health Insurance Plans (AHIP).

The new study echoes the findings of an earlier analysis of AHIP member data showing that seniors in Medicare health plans can receive higher quality care compared to fee-for-service (FFS) Medicare.

"Medicare Advantage plans coordinate care, help seniors manage chronic conditions, and focus on prevention to help seniors stay healthy in the first place," said Karen Ignagni, President and CEO of AHIP.

Instead of focusing almost exclusively on treating beneficiaries when they are sick, Medicare Advantage plans place a strong emphasis on preventive health care services that detect diseases at an early stage and disease management programs for seniors with chronic illnesses to help them keep their conditions under control. These programs are working to help keep patients out of the hospital and avoid potentially harmful complications.

The new study analyzed statewide datasets on hospital admissions in California and Nevada compiled by the Agency for Healthcare Research and Quality (AHRQ). The unique data in these states allows for direct comparisons of utilization rates among enrollees in Medicare Advantage plans and in FFS Medicare. These comparisons were adjusted for health status using the Medicare risk score process for age, sex, and 70 Hierarchical Condition Categories that are used as a basis for Medicare risk adjustment. Key findings from the report include:

• Medicare Advantage beneficiaries in California spent 30 percent fewer days in the hospitals than patients with FFS Medicare, and in Nevada, seniors in Medicare Advantage plans spent 23 percent fewer days in the hospital.
• Medicare Advantage enrollees were re-admitted to the hospital in the same quarter for the same condition 15 percent less often in California and 33 percent less often in Nevada compared to FFS Medicare.
• In both California and Nevada, seniors in Medicare Advantage were 6 percent less likely than seniors in FFS Medicare to be admitted to the hospital for conditions described by AHRQ as "potentially avoidable," such as dehydration, urinary tract infection, or uncontrolled diabetes.

The new analysis follows a previous AHIP study comparing utilization rates among patients in eight Medicare health plans compared to seniors in FFS Medicare. This study among seniors with certain chronic conditions in California and Nevada also found that:

• Medicare Advantage beneficiaries spent an average of 18 percent fewer days in the hospital than seniors in FFS Medicare.
• Seniors in Medicare Advantage had an average of 27 percent fewer visits to the emergency room than those seniors in traditional Medicare.
• Seniors enrolled in Medicare Advantage health plans also experienced a 42 percent lower rate of hospital re-admissions than those seniors in FFS Medicare.
• Avoidable admissions to the hospital were 13 percent lower among seniors in Medicare Advantage plans than those in traditional Medicare.

Policymakers and stakeholders recognize that reducing preventable hospital admissions and readmissions are important steps towards improving the quality and safety of patient care and helping to put our health care system on a more sustainable path. These studies demonstrate that the programs Medicare Advantage plans have implemented provide a model for how this can be accomplished.

The health care reform proposals currently being considered in Congress include significant cuts to the Medicare Advantage program that would risk the health security of millions of seniors across the country. Seniors would face higher premiums, reduced benefits, and, in some parts of the country, would lose access to their Medicare Advantage plan altogether.

"The entire Medicare program, including Medicare Advantage, should be carefully evaluated as part of comprehensive health care reform. However, seniors in Medicare Advantage should not be forced to fund a disproportionate share of the costs to reform the health care system," said Ignagni.