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New Study in AJMC Provides Further Evidence of the Effectiveness of Medicare Advantage Plans in Addressing One of the Most Pressing Problems in Health Care Today



Tuesday, February 28, 2012 Robert Zirkelbach (AHIP), 202-778-8493

Cheryl Sarfaty (AJMC), 609-716-7777 ext. 235

Jason Rose (MedAssurant), 301-809-4000

New Study in AJMC Provides Further Evidence of the Effectiveness of Medicare Advantage Plans in Addressing One of the Most Pressing Problems in Health Care Today

Study Highlights Value of Medicare Advantage in Helping Patients Avoid Preventable Hospital Readmissions

Washington, DC — As the nation continues to focus on the crucial patient safety implications of avoiding preventable hospital readmissions, a new study contributes fresh evidence to the mounting body of work indicating that hospital readmission rates are lower in Medicare Advantage (MA) than in Medicare fee-for-service (FFS).

In the new study, published in the February issue of the American Journal of Managed Care (AJMC), unadjusted 30-day readmission rates for MA patients were approximately 14.5% from 2006-2008, 22% lower than FFS. Taking into account risk adjustment and demographic information, data from the same time period show MA 30-day readmission rates to be 13% to 20% lower than traditional Medicare FFS rates. The study was conducted by MedAssurant, Inc., and America’s Health Insurance Plans (AHIP).

Preventing avoidable hospital admission and protecting patients from the risks associated with inpatient settings, such as infection, are indications that patients are getting the care and services they need on an outpatient basis to stay healthy and avoid complications that can lead to hospital readmissions. Identifying improvement in this area as a national priority, the U.S. Department of Health & Human Services’ Partnership for Patients set a goal to reduce preventable hospital readmission by 20 percent by the end of 2013.

The transitional care interventions used by MA plans and improved communication among providers of care have been shown to play a role in reducing readmission rates and are being looked to as a model elsewhere in the health care system.

“Health plans have played a game changing role in bringing programs to the delivery system that are helping patients get appropriate follow-up care and avoid preventable hospital readmission,” said Karen Ignagni, President and CEO of AHIP.

The new study “Hospital Readmission Rates in Medicare Advantage Plans,” by Lemieux et al., aims to create a national benchmark for readmission rates among MA patients to make it possible to track continued progress in lowering MA readmission rates over time.

MedAssurant, a leading health care research and solutions provider, has a large dataset uniquely suited to address the question of hospital readmissions, and includes data from all 50 states.

“There is no doubt that reducing avoidable readmissions is an important factor that merits continued assessment and focus in models of care that effectively drive quality and financial outcomes,” said Keith Dunleavy, M.D., President and Chief Executive Officer of MedAssurant. “Key to identifying successful paradigms of improvement is a deep understanding of data and a willingness to analyze and hone improvement efforts. This study gives strong support to the claimed success of initiatives designed to improve care and quality which ultimately lead to lower readmission rates in Medicare Advantage programs.”

To access a copy of the full article, please click here. There will also be a breakfast briefing next week (March 7) at AHIP’s National Policy Forum entitled “Hospital Readmissions Rates in Medicare Advantage Plans” where these findings will be discussed. Click here to view the entire schedule for the Policy Forum.

The AJMC study follows a series of studies by AHIP researchers and others comparing patterns of care among patients with Medicare Advantage coverage and in the FFS Medicare program. This includes a recent report published in Health Affairs that compares utilizations rates among beneficiaries with diabetes in an MA special-needs plan to similar beneficiaries in FFS Medicare. People with diabetes in the special-needs plan had more primary care office visits and fewer hospital admissions and readmissions than beneficiaries in FFS Medicare.

A recent AHIP publication, Innovations in Reducing Preventable Hospital Admissions, Readmissions, and Emergency Room Use, provides company specific examples of the types of programs and services that health plans have implemented to reduce preventable hospital admissions, readmissions, and emergency room visits. Examples of the types programs include the following:

  • Expanding patient access to urgent care centers, after-hours care, and nurse help lines give patients safe alternatives to emergency rooms for non-emergency care.
  • Arranging for phone calls and, in some cases, in-home visits by nurses and other professionals to make sure that follow-up appointments are kept, medications are being taken safely, care plans are being followed, medical equipment is delivered, and home health care is being received.
  • Offering intensive case management to help patients at high risk of hospitalization access the medical, behavioral health, and social services they need.
  • Arranging for home visits by multidisciplinary teams of clinicians, who provide comprehensive care, teach patients and their caregivers how to take medications correctly, and link families with needed community resources.
  • Revamping physician payment incentives to promote care coordination and improved health outcomes.


America’s Health Insurance Plans — Providing Health Benefits to More Than 200 Million Americans

About The American Journal of Managed Care

The American Journal of Managed Care is an independent, peer-reviewed publication dedicated to publishing original research in healthcare outcomes and creating a forum for scientific communication in the ever-evolving field of healthcare delivery. The journal is indexed in MEDLINE/PUBMED. AJMC is published by the Intellisphere Managed Market Group, which is owned by MJH & Associates. For more information, please contact Tobin Sharp, Group Editorial Director, The American Journal of Managed Care at 609.716.7777 or tsharp@ajmc.com.

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