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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
For Immediate Release
February 28, 2012
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
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
To access a copy of the full article, please click
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
- 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
- Revamping physician payment incentives to
promote care coordination and improved health outcomes.
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