Illuminating healthcare: The impact of Medicare Advantage and Medicare Fee-for-Service on the quality of healthcare
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Inovalon
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In the ever-evolving landscape of healthcare, understanding the nuances of different care models is crucial. In the third part of our research series leveraging Inovalon’s comprehensive data assets and quality analytics capabilities, we have uncovered remarkable differences in the quality of care between Medicare Advantage (MA) and Medicare Fee-For-Service (FFS) programs.
This segment of our research collaboration with Harvard Medical School looks to answer the question: Does MA deliver better quality of care and more equitable health outcomes for Medicare beneficiaries in comparison to traditional FFS?
The white paper delves deep into the impact of these programs, revealing not just the disparities but also the potential revolutionary opportunities to improve the healthcare system.
Improved quality of healthcare outcomes under MA
Our research found evidence that MA beneficiaries experience significantly better healthcare quality outcomes compared to their FFS counterparts, especially after adjusting for differences in who enrolls in the two programs and for disadvantages faced by MA members in terms of their demographic, clinical, and social risk factors before joining Medicare. Notably, MA substantially reduces preventable acute hospitalizations, indicating better management of health complications. Moreover, MA drastically lowers rates of inpatient readmissions by 70%, even after accounting for differences existing before Medicare enrollment. This result builds on previous findings, which indicated that MA had lower overall utilization than FFS.
Targeted medication management
MA’s positive impact extends beyond hospital care. We also discovered a remarkable 20% reduction in inappropriate medication use under MA while maintaining overall medication use. MA’s ability to reduce inappropriate medication use not only implies that MA is providing high-value care, but also addresses a critical issue faced by older adults: adverse drug events due to lack of communication between healthcare providers. Studies have shown that 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.1 MA’s care coordination is evident in the significant decrease in the use of high-risk medications, ensuring the safety of older adults.
Implications and future considerations
These findings challenge the traditional healthcare model by highlighting the shortcomings of FFS, particularly its lack of care management and the adverse impact on health outcomes. This research emphasizes the importance of care coordination, a feature more prevalent in MA, and suggests that overall utilization reductions under MA come through improved care quality rather than impaired access to care. This study has revealed that MA is superior in delivering enhanced outcomes for patients while reducing the overall cost of care. Moreover, the research suggests that the true potential of MA might not have been fully captured in this study which evaluated outcomes over the course of a year and may be missing quality improvement results that take longer to materialize.
Real-world implications
In a world where healthcare quality is paramount and the ever increasing cost of healthcare presents challenges to equitable care, this research stands as a testament to the transformative power of comprehensive healthcare models like MA. The study’s findings not only validate the effectiveness of MA in improving patient outcomes but also underscore the urgent need for a shift in the broader healthcare paradigm.
Moving forward, it is imperative for healthcare providers, policymakers, and patients alike to consider the implications of this research.
By working together to usher in an era where superior quality of care is accessible to all, we can build a roadmap toward a healthier, more efficient healthcare ecosystem.
Sources:
1Radcliff, S., J. Yue, G. Rocco, S.E. Aiello, E. Ickowicz, Z. Hurd, M.J. Samuel, and M.H. Beers. 2015. “American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.” Journal of the American Geriatrics Society 63(11): 2227–46.
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