Medicare Advantage Has Been Linked to Lower Hospitalization Rates


Medicare Advantage enrollees have lower avoidable hospitalization rates than traditional fee-for-service Medicare patients.

A study published by the Robert Graham Center found that patients enrolled in Medicare Advantage (MA) have lesser marker condition hospitalization and avoidable hospitalization rates than traditional fee-for-service Medicare (TM) enrollees.

In this study, marker condition hospitalization refers to hospitalization that could not be prevented by a primary care physician or during ambulatory care. Avoidable hospitalization refers to anything that would have been preventable by primary care physicians.

Researchers gathered data from the 2012 and 2013 hospital utilization data from the Healthcare Cost and Utilization Project (HCUP). This data was gathered from 12 states with complete data.

The selected 12 states had 13.5 million Medicare beneficiaries.

HCUP does not differentiate different types of MA plans, such as health maintenance organizations or preferred provider organizations. All plans were put into the same category.

Only patients who were 65-years or older were included in this study.

Avoidable hospitalization rates of both MA and TM patients were compared with marker condition hospitalization.

After comparing data, researchers found that there was an avoidable hospitalization decrease of 10% in MA patients. MA patients were also more likely to have referral-sensitive hospitalizations due to better outpatient care.

Research also found that counties with a higher rate of MA patients had lower avoidable hospitalization rates.

They also showed higher referral-sensitive hospitalization rates among both MA and TM patients, referred to as an MA spillover effect. Researchers note that this is a positive effect.

The study authors stated that more research is needed to explain if the positive effects of MA enrollment are due to the way it promotes efficiency, coordination, and primary care.

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