Tuesday, March 5, 2013

Medicare Advantage: Providing Quality Care to More than 14 Million Beneficiaries

Private health plans have a strong track record of providing quality care to the more than 14 million seniors and people with disabilities enrolled in Medicare Advantage. Beneficiaries have chosen to enroll in Medicare Advantage because they value the improved quality of care, additional benefits, and innovative services health plans provide.

Beneficiaries are increasingly enrolling in Medicare Advantage plans because of advancements in care offered by these plans. Health plans have developed systems of coordinated care for ensuring that beneficiaries receive health care services on a timely basis, while also emphasizing prevention and providing access to disease management services for their chronic conditions. These coordinated care systems provide for the seamless delivery of health care services across the continuum of care. Research has shown that these efforts are working by increasing primary care visits, managing chronic conditions, and reducing preventable hospital readmissions.

A few examples:
  • One recent study published in the American Journal of Managed Care (AJMC) found that the Medicare Advantage readmission rate was about 13 percent to 20 percent lower than that in the Medicare FFS program.
  • Additional research co-authored by researchers affiliated with The Brookings Institution concluded that Medicare Advantage plans outperformed the Medicare FFS program in 9 out of 11 clinical quality measures.   This means that Medicare Advantage enrollees received the level of effective care recommended by a doctor with greater frequency than patients in Medicare FFS, for 9 of the 11 procedures studied.
  • A study published in the January 2012 edition of Health Affairs found that beneficiaries with diabetes in a Medicare Advantage special needs plan (SNP) had “seven percent more primary care physician office visits; nine percent lower hospital admission rates; 19 percent fewer hospital days; and 28 percent fewer hospital readmissions compared to patients in FFS Medicare.”
Medicare Advantage enrollees also receive a number of additional services not included in the Medicare fee-for-service (FFS) program. These may include:
  • Case management services
  • Disease management programs
  • Coordinated care programs
  • Prescription drug management tools integrated with medical benefits
  • Tools and data collection to address disparities in care for racial and ethnic minorities
  • Nurse help hotlines
  • Enhanced coverage of home infusion, personal care and durable medical equipment
  • Personal health records to offer beneficiaries greater control over their health information and to coordinate information better
  • Vision, hearing, and dental benefits coordinated with medical services
Medicare Advantage plans are a valuable resource in protecting beneficiaries from unpredictable out-of-pocket costs. In 2012, all Medicare Advantage plans offered an out-of-pocket maximum limit for beneficiary costs, and about 78 percent of Medicare Advantage enrollees are in plans that have annual out-of-pocket maximums of $5,000 or less. These out-of-pocket maximums – which are not offered by the Medicare FFS program – help protect Medicare beneficiaries from catastrophic health care expenses that otherwise might pose a serious threat to their financial security.  Medicare Advantage plans also help reduce out-of-pocket costs for enrollees by reducing premiums for Part B and Part D, and by limiting cost-sharing for Medicare-covered services, including primary care physician visits and inpatient hospital stays.

This financial protection is especially valuable to the low-income beneficiaries enrolled in Medicare Advantage, many of whom are not eligible for Medicaid and do not have employer-sponsored retiree benefits. A new survey found that 41 percent of Medicare beneficiaries with Medicare Advantage coverage had incomes of $20,000 or less, and 27 percent had incomes of $10,000 or less. These findings demonstrate that Medicare Advantage plans are a lifeline to those beneficiaries who cannot afford the high out-of-pocket costs they would incur under the Medicare FFS program.

http://www.ahipcoverage.com/2013/02/26/medicare-advantage-providing-quality-care-to-more-than-14-million-beneficiaries/

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