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Medicare Advantage Beneficiaries Have Superior Quality Outcomes Relative to Traditional Medicare

Medicare Advantage Beneficiaries Have Superior Quality Outcomes Relative to Traditional Medicare

New Research From Inovalon and Harvard University Finds Medicare Advantage Beneficiaries Have Superior Quality Outcomes Relative to Traditional Medicare

Data Shows Lack of Care Management and Coordination of Services in Fee-for-Service Medicare Leads to Lower Quality of Care and Worse Outcomes

  • Medicare Advantage (MA) has 70% fewer readmissions than Fee-for-Service (FFS) Medicare
  • MA has 24% fewer preventable hospitalizations than FFS, primarily driven by 59% fewer preventable acute hospitalizations
  • MA has 21% lower rates of high-risk medication use, while overall medication use is in line with FFS

Inovalon, a leading provider of cloud-based software solutions empowering data-driven healthcare, and Harvard Medical School researchers today released new research that shows Medicare Advantage (MA) delivers superior quality and health outcomes relative to traditional Fee-for-Service (FFS) Medicare. Using Inovalon’s unique data assets and analytics to look at a broad range of quality measures across care settings, the research shows that patients enrolling in MA realize substantially reduced rates of chronic and acute care complications. The findings are the latest to be released from the first-of-its-kind research collaboration with Inovalon and Harvard Medical school and builds on earlier research showing substantial inpatient utilization reductions under MA.

MA now covers more than half of Medicare beneficiaries, including a disproportionately large share of socioeconomically disadvantaged patient populations. Despite the growing popularity of MA plans, limited information is available on how care quality differs under MA and FFS coverage. The study, “Quality Outcomes Under Medicare Advantage versus Medicare Fee-for-Service,” found consistently better quality outcomes under MA than FFS, including 70% fewer readmissions under MA. MA also had 24% fewer preventable hospitalizations, with 59% fewer preventable acute hospitalizations. In addition, the study found 21% lower rates of inappropriate high-risk medication use under MA while overall medication use was similar in MA and FFS.

“The study provides strong evidence that care management and coordination are key to better outcomes,” said Boris Vabson, PhD, health economist at Harvard Medical School and co-lead researcher on the project. “While recent reforms such as the introduction of Accountable Care Organizations (ACOs) have attempted to improve Medicare care management, our research shows additional steps are needed to improve care coordination and quality of care under Fee-for-Service Medicare.”

To quantify the impact of MA vs. FFS on key quality outcomes, the research team analyzed quality measures for a large, nationally representative population over a two-year timespan as beneficiaries transitioned from commercial insurance to MA or FFS coverage, while accounting for pre-existing differences prior to Medicare enrollment. This unique study was made possible through the use of data from Inovalon’s Medical Outcomes Research for Effectiveness and Economics (MORE2) Registry®, the nation’s largest primary source healthcare dataset covering 100% of public Medicare lives and 30% of all private insured lives.

“We believe this data can help health plans identify opportunities for quality improvement, especially for those in our health system who have been historically underserved and are at higher risk of needing complex care,” said Christie Teigland, PhD, Vice President of Research Science and Advanced Analytics at Inovalon and co-lead researcher on the project. “Under the new CMS Health Equity Index framework, it will be imperative for health plans to address socioeconomic disparities to improve 5-Star ratings and qualify for bonus payments. Our research gives them the insights they need to maximize financial incentives and, most importantly, promote health equity and deliver better health outcomes.”

Future research will look at specific, actionable opportunities for improving care quality and outcomes from a policy and plan design perspective.

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