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People enrolled in Medicare Advantage (MA) plans—or Medicare-approved private health insurance—are less likely to have emergency doctor visits or inpatient hospital stays than traditional fee-for-service (FFS) Medicare beneficiaries, researchers have found.
A newly released study from health software provider Inovalon and Harvard Medical School researchers compared healthcare utilization and expenditures, or the use and costs of services, between traditional FFS Medicare and MA enrollees.
Researchers found that MA beneficiaries—who account for just over half of Medicare enrollees and $450+ billion in total federal spending—had significantly lower health utilization and expenditures than their FFS counterparts. FFS Medicare enrollees also had higher utilization and spending than people with standard commercial insurance.
The study’s findings—which tracked MA and FFS utilization trends from two years prior to Medicare enrollment to two years after—offer new insights to health plan companies and policymakers and could “drive both quality and cost improvements,” researchers noted in a white paper. The analysis used Inovalon’s MORE2 Registry, a healthcare dataset with administrative data on 372 million patients.
Christie Teigland, Inovalon’s VP of research science and advanced analytics, stressed the importance of assessing MA’s effectiveness “as the program continues to rapidly grow in terms of lives covered and dollars spent.”
“Our study demonstrates how active care management and preventive care offered under MA is helping beneficiaries better manage their health in cost-effective ways,” she said in a statement. “This data and other insights from our findings offer the industry a glimpse into the strategies that are working to meaningfully improve healthcare, including the health of the most disadvantaged elderly beneficiaries.”
MA enrollees had more than a 50% lower inpatient stay rate and 22% lower emergency doctor visit rate than FFS enrollees, despite relatively comparable amounts of primary and routine care, researchers found. MA beneficiaries had a 7% lower primary care provider visit rate and similar prescription drug utilization.
FFS enrollees had higher utilization and healthcare spending compared to patients with standard commercial coverage—a 20% increase immediately after transitioning to Medicare and a 35% increase within two years, according to the study. By contrast, MA enrollee utilization remained largely flat both before and after joining Medicare.
Researchers largely attributed the FFS spike to higher rates of inpatient utilization as beneficiaries transition from commercial to Medicare coverage—not delayed care or higher rates of illness. That finding, they noted in the white paper, is “not altogether surprising, given that FFS program design also deviates from other common insurance types,” lacking active patient management and care coordination.