Medicare Advantage patients use fewer services, study says

Medicare beneficiaries enrolled in private health maintenance organization plans utilized fewer services compared with patients with traditional coverage during a seven-year period, according to a study in the December Health Affairs.

Researchers analyzed health care utilization trends for seniors with private and public Medicare plans from 2003-09. They found fewer trips to emergency departments and ambulatory surgery centers for patients with a Medicare Advantage HMO plan.

Enrollment in Medicare Advantage has grown significantly, to the point where one in four seniors had the private plan coverage in 2012. Medicare Advantage plans have been criticized for costing the government more than traditional Medicare. Reforms to make plans more competitive have been signed into law in recent years.

New research may lead observers to find that Medicare Advantage can control utilization of the program’s costlier services. Emergency department visits were 25% to 35% lower for Medicare Advantage patients during the study’s time frame, while inpatient medical days were about 20% to 25% below rates for those with traditional Medicare fee for service. Ambulatory surgery rates were 25% lower in 2003, but differences between the two types of coverage had narrowed to 7% by 2008.

“Supporters of Medicare Advantage argue that managed care will lead to more efficient use of services, typically by avoiding low-value use of discretionary services and encouraging more use of recommended services,” the authors wrote. “Although our findings are generally consistent with this view, research with more clinical data and health outcomes … is needed to assess potential explanations for differences in care and also how these relate to future reform efforts under the Affordable Care Act.”

The article is available online (link).