Study Shows Medicare Advantage Enrollees Benefit From Private Sector Innovations.

America’s Health Insurance Plans (AHIP), last week, released a study that supports the position often taken in this blog. That is that innovations that lead to better and lower cost medical care come from private sector initiatives.

AHIP released a study showing that Medicare Advantage enrollees spent fewer days in a hospital, were subject to fewer hospital re-admissions, and were less likely to have “potentially avoidable” admissions for common conditions examined by the study.  The study was based on an analysis of statewide datasets on hospital admissions in California and Nevada compiled by the Agency for Healthcare Research and Quality (AHRQ).

”The study’s findings,” according to AHIP, “demonstrate that the innovative programs developed by Medicare Advantage plans – which place a strong emphasis on preventive health care services that detect diseases at an early stage and disease management programs for seniors with chronic illnesses – are working to help keep patients out of the hospital and avoid potentially harmful complications.”

Key findings from the report include:

  • Medicare Advantage beneficiaries in California spent 30 percent fewer days in the hospital than patients with FFS Medicare, and in Nevada, seniors in Medicare Advantage plans spent 23 percent fewer days in the hospital.
  • Medicare Advantage enrollees were re-admitted to the hospital in the same quarter for the same condition 15 percent less often in California and 33 percent less often in Nevada compared to FFS Medicare.
  • In both California and Nevada, seniors in Medicare Advantage were 6 percent less likely than seniors in FFS Medicare to be admitted to the hospital for conditions described by AHRQ as “potentially avoidable,” such as dehydration, urinary tract infection, or uncontrolled diabetes.

It seems to me that this speaks to the fact that care is better coordinated when seniors are engaged with a private carrier rather than directly with Medicare. There is no management in Medicare, just a payment system. This is what has many concerned about the prospect of a government health plan.

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