Medicare Advantage Beneficiaries Do Better On Outcomes, Costs

Patients enrolled in Medicare Advantage programs outperformed traditional fee-for-service (FFS) on several key quality measures, according to a new report from Avalere.

MA beneficiaries in Avalere’s study had 23% fewer inpatient stays and 33% fewer emergency room visits than FFS Medicare beneficiaries. MA beneficiaries received more preventive physician tests and services, while FFS Medicare beneficiaries had more inpatient stays and outpatient/emergency care services.

In addition MA beneficiaries did better than FFS beneficiaries on health outcomes and cost-savings. Dual-eligible beneficiaries, who receive benefits from both Medicare and Medicaid, had 33% fewer hospitalizations and 42% fewer emergency room visits, compared with those in FFS Medicare, and lower health care costs compared with FFS dual-eligible beneficiaries. MA dual-eligibles also saw their primary care providers more frequently.


“MA plans’ focus on preventive care may help avoid downstream utilization of high-cost services driven by acute-care and emergency needs,” Christie Teigland, vice president at Avalere, said in the report’s executive summary.

Acute care is a particular pain point for costs; cutting emergency room usage could save billions of dollars, according to Joel White, President and CEO of Horizon Government Affairs, a Washington, D.C.-based consulting firm. One company, Brooklyn, N.Y.-based Call9, embeds paramedics on-site in skilled nursing facilities and has cut hospitalizations at the Archdiocese of New York’s Terence Cardinal Cooke nursing facility. Other companies have focused on transitions of care by adding nurses and following up with patients after discharge from a skilled nursing facility.

MA plans have flexibility in utilizing certain care settings, including their ability to transition patients directly to a SNF without mandating a longer hospital stay, the Avalere report noted.


Meanwhile MA plans are growing at a rapid clip, with payments to such plans for services covered under Part A and Part B almost doubling between 2007 and 2017.

“Our findings present new evidence for Medicare Advantage’s value proposition, especially for high-need beneficiaries,” Dan Mendelson, founder of Avalere, said.

Written by Maggie Flynn

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