Americans who qualify for both Medicare and Medicaid receive better quality care when they’re treated through a value-based model under Medicare Advantage, according to a peer-reviewed study published in the American Journal of Managed Care.
Why it matters
Health care costs for dual-eligible patients are rising fast. People who qualify for both programs – based on their age, disability, health and income – account for 19% of the Medicare population and 35% of the program’s spending last year.
The methods
Researchers compared the health outcomes of patients from more than 15,000 primary-care providers enrolled in three Medicare payment models: at risk Medicare Advantage, FFS Medicare Advantage and traditional Medicare.
The findings
Patients under Medicare Advantage plans had better outcomes in at least 17 of 20 measurements, including hospitalization and emergency department use, compared to those in fee-for-service Medicare Advantage and Traditional Medicare.
By the numbers
Patients under at-risk Medicare Advantage had:
- 24% fewer hospital admissions as compared to those enrolled in traditional Medicare.
- 29% fewer emergency department visits as compared to those enrolled in traditional Medicare.
- 32% fewer readmissions within 30 days of a prior hospital stay as compared to those enrolled in traditional Medicare.
“Our latest findings add to the growing body of evidence associated with value-based care. Physicians working under value-based care models have the time and flexibility to prioritize preventative care, which results in better outcomes for economically disadvantaged patients most in need of care coordination and dedicated support.”
Dr. Ken Cohen | Executive Director of Translational Research, Optum
The big picture
This is the fourth study in a growing body of peer-reviewed literature that demonstrates patients receive higher quality care when physician groups take on the financial responsibility for the health outcomes of their patients.
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