Care Quality, Health Outcomes Better in Medicare Advantage than FFS

Medicare Advantage beneficiaries experience higher quality care and better health outcomes than fee-for-service beneficiaries, according to a report from Harvard and Inovalon.

Researchers used Inovalon’s claims data to assess care quality for people enrolled in Medicare Advantage and those with Medicare fee-for-service between 2015 and 2019.

During the year following Medicare enrollment, fee-for-service beneficiaries had 3.6 times higher rates of 30-day hospital readmissions compared to Medicare Advantage beneficiaries. People with fee-for-service also had 1.6 times higher rates of potentially avoidable hospitalizations, with 2.5 times higher rates for acute conditions and 1.3 times higher rates for chronic conditions.

After controlling for patient characteristics, hospital readmissions were 3.8 times more likely in fee-for-service than Medicare Advantage.

Rates of inappropriate use of high-risk medications were 1.6 times higher in fee-for-service and 1.4 times higher after controlling for patient characteristics. When focusing on measures of treatment appropriateness, rates of high-risk medication use were 21 percent lower in Medicare Advantage.

“This suggests that MA is able to target inappropriate care while retaining high-value care, particularly since we previously found that rates of overall medication use under MA and FFS were comparable,” researchers wrote. “Avoiding the use of high-risk drugs is an important and effective strategy for reducing medication-related problems and adverse drug events in older adults.”

Medication adherence for hypertension, diabetes, and cholesterol treatment was similar in fee-for-service and Medicare Advantage. Initiating and engaging in treatment for alcohol and other drug abuse were also similar in the two programs.

After adjusting for pre-existing differences between Medicare Advantage and fee-for-service beneficiaries, Medicare Advantage had 24 percent fewer preventable hospitalizations relative to fee-for-service. For preventable acute-related hospitalizations, there were 59 percent fewer instances in Medicare Advantage. The rate of preventable chronic hospitalizations was 8.6 percent lower in Medicare Advantage.

Additionally, there were 70 percent fewer 30-day all-cause readmissions in Medicare Advantage than in fee-for-service after adjusting for differences present before Medicare enrollment.

Past research has indicated that Medicare Advantage beneficiaries have lower healthcare utilization than fee-for-service beneficiaries. These findings suggest that the lower utilization reflects improved care quality rather than poorer access to care.

Additionally, the results show the potential benefits of care management and coordination, which are more common in Medicare Advantage than fee-for-service.

They also highlight how the lack of this care management in fee-for-service can negatively impact beneficiaries. Medicare fee-for-service has attempted to improve care through accountable care organizations and value-based initiatives, but these have not sufficiently addressed the minimal care management, the researchers said.