Medicare Advantage beneficiaries with diabetes, high blood pressure and high cholesterol spend less time in the hospital than those in fee-for-service Medicare plans, according to a report from the consulting group Avalere, commissioned by the Better Medicare Alliance.
The report found that MA beneficiaries with at least one of those three conditions have higher rates of seeing their physician (11 to 12 times annually), compared with their counterparts enrolled in an FFS Medicare plan (10.1 to 10.5 times per year).1 They also had “lower rates of inpatient utilization” (442 to 511 per 1,000 MA beneficiaries) than those enrolled in FFS Medicare plans (573-665 per 1,000).1
MA beneficiaries in this patient population had lower overall per-member-per-month spending on healthcare than FFS Medicare enrollees.1 The reduced spending was seen across all types of expenditures that were analyzed, which included acute inpatient, ambulatory outpatient, prescription drug and other medical costs.1 Meanwhile, total spending was lower among MA beneficiaries across all the subgroups analyzed in the report.
According to the report, a greater percentage of MA beneficiaries (28.1%) identified as racial or ethnic minorities than people in FFS Medicare plans (12.8%).1,2 Also, more MA beneficiaries were enrolled in a plan because of a disability (27.0%), compared with those in an FFS Medicare plan (21.6%).1,2
The report’s authors noted that the prevalence and treatment of the three conditions “can vary considerably by beneficiaries’ demographic characteristics, race, ethnicity, and geography, resulting in differential outcomes and spending.”1
Implementing effective care management programs for this patient population to enhance health care delivery and quality of care “can improve health outcomes and reduce costs,” the authors wrote.1
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- Analysis of Medicare Advantage Enrollee Demographics, Utilization, Spending, and Quality Compared to Fee-for-Service Medicare Among Enrollees with Chronic Conditions. Avalere Health. June 2023. https://bettermedicarealliance.org/wp-content/uploads/2023/06/BMA-MA_FFS-Outcomes-Among-Beneficiaries-with-Chronic-Conditions_FIN-1.pdf
- Wilson, Rylee. 5 Ways Medicare Advantage, fee-for-service differ on care for chronic conditions: Report. Becker’s Payer Issues. June 29, 2023. https://www.beckerspayer.com/payer/5-ways-medicare-advantage-fee-for-service-differ-on-care-for-chronic-conditions-report.html