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Medicare Advantage Plans Outperform Fee-For-Service Medicare in Caring for Dual-Eligible Beneficiaries with Chronic Conditions

Summary

Avalere experts will present “Comparing Utilization, Cost and Quality in Dual Eligible Medicare Advantage and Fee-For-Service Medicare Beneficiaries” at the International Society for Pharmacoeconomics and Outcomes Research meeting on May 21.

The research examines healthcare utilization, cost, and quality outcomes across 2 large national samples of dual eligible Medicare Advantage (MA) and Fee-for-Service (FFS) Medicare beneficiaries with 1 or more of 3 chronic conditions selected from the top-5 conditions based on prevalence in the Medicare population: hypertension, hyperlipidemia, and diabetes. It is important to note that there has been little published information comparing the performance of MA and traditional FFS Medicare due in part to a lack of access to comparable MA encounter data similar to the FFS data that have been studied extensively.

The team 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.

Avalere’s research found that MA outperformed FFS Medicare on overall cost of care (16.7% higher in FFS), quality measure outcomes, and utilization of high cost health services such as inpatient and emergency room visits when it came to caring for dual eligible beneficiaries with chronic conditions. Dual eligible beneficiaries experienced significantly lower rates of complications, avoidable hospitalizations and readmissions, and received more preventative care services compared to dual eligible FFS Medicare beneficiaries. These findings suggest that MA plan flexibility to provide additional benefits and coordinate care results in better outcomes and lower costs for Medicare.

Figure 1: Healthcare Costs for Dual and Non-Dual Eligible Beneficiaries in Medicare Advantage and FFS Medicare Study Populations
Healthcare Costs for Dual and Non-Dual Eligible Beneficiaries in Medicare Advantage and FFS Medicare Study Populations

View the research poster.

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