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Medicare Advantage Quality

By July 31, 2013Commentary

Ever since the introduction of Medicare Advantage plans and their predecessors, certain idealogues have tried to undermine and discredit the program.  And while MA may cost more for a beneficiary than the fee-for-service program would spend, the beneficiary typically gets better benefits and according to most research, better quality and coordination of care.   (HA Article)   In a new study the authors looked at care between 2003 and 2009 for matched beneficiaries in Medicare Advantage and in the fee-for-service program.  The primary measures were HEDIS data and CAHPS surveys of satisfaction.  Even without accounting for spillover effects from Medicare Advantage to the fee-for-service population, MA plans shows a pretty wide gap in performance on several measures.  Mammography rates were 13.5% higher; HbA1c testing for diabetic patients was 8.6% higher, eye exams for patients with diabetes were 17.1% greater, and cholesterol testing was 7% to 9% higher.  Rates of flu and pneumonia vaccinations were similar.  Ratings of physicians in the satisfaction surveys were basically the same, with a slight edge for MA for primary care physicians.  Non-profit, larger and longer operating health plans showed the greatest gap in quality performance versus the fee-for-service program.  The study used mostly process of care measures, not actual health outcomes, but it strongly suggests that fears that MA plans would be incented to skimp on care are unfounded and that it is the uncoordinated, unmanaged fee-for-service program that is delivering more sub-optimal care.

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