A new peer-reviewed paper published in the American Journal of Managed Care shows Medicare Advantage (MA) enrollees whose physicians were under fully accountable models — taking full risk for the costs and quality of their care — have dramatically better health outcomes than patients enrolled in traditional fee-for-service Medicare, even when cared for by the same physicians.
By the numbers
Compared to traditional Medicare patients, outcomes for patients in two-sided value-based care models were superior across 16 of 20 measures. Key findings show that MA patients were:
up to 43%
less likely than traditional Medicare patients to be hospitalized for acute and chronic conditions, showing that patients are experiencing better overall health and fewer severe health episodes.
39%
less likely to be readmitted to a hospital within 30 days of being discharged, indicating that patients are receiving high-value care coordination leading to effective follow-up care.
19%
less likely to undergo avoidable hospital emergency department care, reducing the strain on emergency services and lowering health care expenses.
23%
less likely to use high-risk medications that can be harmful or fatal if used incorrectly.
This is the third in a series of peer-reviewed studies that demonstrate superior outcomes for MA patients in fully accountable value-based care arrangements. The first paper shows that the advantages of value-based care can extend — or “spill over” — beyond MA patients to other Medicare recipients. The second paper compares two groups of MA enrollees, one group which received care in a fully accountable MA arrangement and another which received care through FFS MA.
“When examining the differences between fully accountable Medicare Advantage and traditional Medicare, we found significant improvements in the MA model that exceeded both of our prior studies. The findings from three rigorous analyses are unequivocal: Fully accountable care in MA provides better outcomes for both our patients and the health care system.”
Dr. Ken Cohen | executive director, Translational Research, Optum Health
Why it matters
The results suggest physician groups operating in fully accountable models have additional resources to focus on preventive care, intensive case management, and other strategies to ultimately deliver better care outcomes for older adults.
Go deeper
Read the article and accompanying infographic for more details.
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