BMA, Avalere Report Shows MA Outperformance on Multiple Care Measures

by Lauren Flynn Kelly

 

A new study from Avalere Health comparing quality outcomes for Medicare Advantage enrollees vs. traditional fee-for-service (FFS) Medicare beneficiaries found that high-need, high-cost populations enrolled in MA had better care experiences for most clinical quality measures and had significantly higher rates of preventive screenings for several measures. While MA didn't outperform FFS across all measures, the findings suggest that care management in MA results in higher quality of care for this vulnerable population, observed the report.

Commissioned by Better Medicare Alliance (BMA), the independent analysis compared performance for similar beneficiaries in three categories: preventive screening and therapy services; inpatient and outpatient services; and management of prescription drugs. Avalere used propensity score matching to control for differences between the MA and traditional FFS population and drew from a nationally representative sample of beneficiaries, resulting in a "matched" study population of 1,262,180 in each group.

Avalere then divided beneficiaries into five clinical segments and focused its findings on three groups in particular: individuals who are under 65 and enrolled in Medicare due to a disability, the frail elderly, and those with chronic, complex conditions.

The study found that "high-cost, high-need" beneficiaries had significantly higher rates of preventive screening compared with similar populations in FFS Medicare. For example, 74% of beneficiaries with major complex chronic conditions and 71% of frail elderly in MA received a pneumonia vaccine, while 49% and 48% of similar beneficiaries, respectively, in FFS received the vaccine. But not all differences were that notable: 77% of the overall FFS population received a cholesterol screening, compared with 75% of MA enrollees, and those results varied across the three high-need groups. On the therapy services side, while the overall MA population had higher rates of initiating treatment for substance misuse or dependence, they were less likely to remain engaged with such treatment.

In addition, the study found that high-need, high-cost MA beneficiaries had substantially lower rates of avoidable hospitalizations and readmissions compared to their FFS counterparts. For example, the average rates of avoidable hospitalizations for acute and chronic conditions among those with major complex chronic conditions were 57% and 45%, respectively, below traditional FFS Medicare. Avalere also found that emergency room visits and costs were significantly greater for frail elderly beneficiaries in MA compared to FFS Medicare.

From Health Plan Weekly