Healthcare utilization is lower in Medicare Advantage than in traditional Medicare, yet clinical quality performance is higher, according to a new study in Health Affairs.1
The study compared MA with traditional Medicare on nine Healthcare Effectiveness Data and Information Set quality metrics and seven patient-reported quality metrics.2
The study looked at data from 2010 to 2017 and found that MA health maintenance organizations performed better on HEDIS clinical quality metrics compared with traditional Medicare for all nine metrics in both years, with the exception of osteoporosis management in 2010.3
The performance difference between MA HMOs and traditional Medicare held steady or increased for seven measures between 2010 and 2017:3
- For breast cancer screening, it grew from 13.8 percentage points to 17.2 percentage points
- For diabetes retinal screening, it grew from 11.6 percentage points to 31.8 percentage points
- For preventive care visits, it grew from 4.4 percentage points to 6.2 percentage points.
MA HMO plans’ performance on patient-reported metrics improved from 2010 to 2017 and surpassed traditional Medicare in all seven metrics in 2017.
Preferred provider organization plans’ quality performance also improved between 2010 and 2017, but the difference in quality between MA PPOs and traditional Medicare was narrower than for HMO plans.2 In both 2010 and 2017, MA PPOs performed equally or better than traditional Medicare on nearly all patient-reported measures.
In addition to better performance, the study also found MA had lower use of emergency department visits, outpatient visits and inpatient admissions than traditional Medicare in both years.3 For example:
- In 2010, relative rates of cardiac catheterization were around 30% to 40% lower for MA beneficiaries versus those in traditional Medicare, and those rates remained steady.
- Rates of elective hip and knee replacements and back surgery were lower in HMOs versus traditional Medicare in 2010, and the differences increased over time.
- Rates of percutaneous coronary intervention were higher in traditional Medicare than in HMOs by 2017.
- Emergency department visits in 2010 were about 40% and 30% lower in MA HMOs and PPOs, respectively, compared with traditional Medicare, although the differences narrowed over time.
- Outpatient and inpatient visits were lower in MA than in traditional Medicare in both years.
The findings, which highlight the MA’s ability to incentivize more limited use of discretionary services while providing a better patient experience, come as the program has been under scrutiny for possible overpayments.3
“As policy makers consider alternatives to address potential overpayments in Medicare Advantage, they should also consider the evidence that MA plans provide fewer services while also achieving equal or better-quality performance relative to traditional Medicare on a broad array of measures,” the authors said.2
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- Landon, B., Zaslavsky, A., Anderson, T., et al. Differences in use of services and quality of care in Medicare Advantage and traditional Medicare, 2010 and 2017. Health Affairs. April 2023. https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2022.00891
- Wilson, R. Medicare Advantage outperformed traditional Medicare on clinical quality, study finds. Becker’s Payer Issues. April 4, 2023. https://www.beckerspayer.com/payer/medicare-advantage-outperformed-traditional-medicare-on-clinical-quality-study-finds.html
- Bailey, V. Medicare Advantage has lower healthcare use, higher clinical quality. HealthPayerIntelligence. April 4, 2023. https://healthpayerintelligence.com/news/medicare-advantage-has-lower-healthcare-use-higher-clinical-quality