More than 33 million seniors, people with disabilities, low-income, and minority communities choose Medicare Advantage (MA) because it has been proven to provide better service, better access, better quality, and better value.
Peer reviewed research shows that MA helps make seniors healthier and reduces preventable hospital admissions. In addition, MA plans provide better access to preventive health care, which can help providers detect illnesses at an early stage and reduce health risks. MA鈥檚 supplemental benefits, care coordination, and focus on detecting and treating preventable diseases at earlier states are helping to create better outcomes. These quality improvements are especially critical to diverse and lower income populations managing chronic conditions. Roughly 54% of Medicare enrollees who belong to diverse populations choose MA and account for a much higher share of all MA enrollees (29%) than their share in Fee-for-Service (FFS) Medicare (19%). In addition, about 38% of MA enrollees have annual incomes of less than $25,000 (by comparison, only 23% of FFS Medicare enrollees have incomes of less than $25,000).
Better Quality and Outcomes
A number of peer-reviewed studies have found that MA plans outperform FFS Medicare across a range of metrics, including better
quality of care and better clinical outcomes.
鈥� Reduced hospitalizations and inappropriate medication use. A recent study from from Harvard Medical School and Inovalon compared MA and FFS Medicare enrollees who turned 65 and found that, after adjusting for enrollment differences across the two programs, MA enrollees had over 70% fewer hospital readmissions and 25% fewer preventable inpatient admissions. That is, after controlling for socioeconomic and patient characteristics, avoidable hospitalizations in FFS Medicare were 1.7 times higher than in MA; and FFS Medicare readmissions were 3.8 times higher than Medicare Advantage. In addition, rates of inappropriate high-risk medication use were 1.4 times higher in FFS Medicare than in MA, while overall medication use was unchanged. To the authors, this suggests 鈥淢A beneficiaries have better quality of care outcomes;鈥� that utilization reductions 鈥渕ay be a direct result of improved quality of care rather than care rationing or reduced access;鈥� and that MA plans 鈥渢arget inappropriate care while retaining high value care,鈥� which the authors note is 鈥渁n important and effective strategy for reducing medication-related problems and adverse drug events in older adults.
鈥� Better results for specific conditions. Studies found better outcomes for patients with specific chronic diseases when they are covered by MA. When compared to patients with FFS Medicare, MA enrollees with end stage renal disease have lower mortality and reduced utilization rates. Further, MA members with diabetes and cardiac disease experienced fewer emergency room visits and hospitalizations and better quality scores compared with those covered under FFS Medicare.
While MA typically serves enrollees reporting poorer health status compared to FFS Medicare 鈥� 47% of MA enrollees self-reported their health as 鈥渆xcellent鈥� or 鈥渧ery good鈥� compared to 53% for FFS Medicare enrollees 鈥� demonstrating that MAbprovides better outcomes and improves seniors鈥� health.
Better Detection and Prevention
鈥� Better detection. Studies have shown MA enrollees are more likely to receive important preventive services like annual wellness exams and cognitive screenings, and influenza and pneumonia vaccinations, than their counterparts in FFS Medicare. A recent study found that MA enrollees are screened more frequently for two of the most common cancers: breast
cancer (73.3% vs 69.9%) and colorectal cancer (38.9% vs 33.1%).6
鈥� Improved treatments and adherence. MA enrollees are more likely to complete treatments, like a course of beta-blockers
after a heart attack, or statin therapy for cardiovascular disease. They are also more likely to receive treatments like disease-modifying drugs for rheumatoid arthritis, management for osteoporosis with fractures, and corticosteroids for chronic obstructive
pulmonary disease.
鈥� HEDIS Scores. A recent study found that MA outperformed FFS Medicare in nine out of 10 Healthcare Effectiveness Data and Information Set (HEDIS) clinical quality measures. Higher performance on key preventive and chronic disease care measures demonstrates that MA enrollees received higher quality care than those in FFS Medicare.