Medicare Advantage and Dual Eligibles

By May 23, 2019 Commentary

Some additional interesting information on the different utilization, spending and quality outcomes for dual eligibles in Medicare Advantage and FFS Medicare is provided in an Avalere paper.   (Avalere Report)   Avalere had access to a large database of dual and non-dual eligibles in each arm of the Medicare program.  Those beneficiaries included in the study had one or more of the following chronic conditions–hypertension, high lipid levels or diabetes.  Dual eligibles in MA were more likely to be older, female, a minority, to have more chronic conditions and to have higher comorbidity scores.  Medicare Advantage non-dual eligibles had average annual spending of $9177, while fee-for-service non-duals had an average of $8357 in annual spending.  Medicare Advantage dual eligibles had average spending of $11159 compared to $13398 for dual eligibles in FFS Medicare.  So despite the apparent higher illness burden for Medicare Advantage dual eligibles, average annual spending was less.  The spending differential is largely due to less inpatient and outpatient hospital spending, while MA duals had more spending on physician visits and related services.  This appears to support the notion that MA encourages more comprehensive primary care and succeeds at avoiding expensive hospitalizations.  This is buttressed by the finding that MA duals had 33% fewer inpatient stays and 42% fewer ER visits, while having 11.7% greater physician visits.

Quality outcomes were generally superior as well for dual eligibles in the Medicare Advantage program.  While access to preventive care and the amount of HbA1C testing (for diabetes) was similar in the two branches, rates of  lipid level testing was 17% in MA, breast cancer screening was 46% better and there were 71% fewer avoidable acute hospitalizations.  Readmission rates were 15% higher among the Medicare Advantage dual eligibles, but this is likely explained by the fact that the initial hospitalizations were much fewer, and therefore likely to be for very sick patients who are more likely to need readmission.  Overall, the results rebut any notion that Medicare Advantage cherrypicks healthier patients.  On the contrary, in regard to dual eligibles, MA appears to enroll sicker members but manage their care better and reduce spending.

This post is available as a podcast at https://anchor.fm/healthy-skeptic/episodes/medicare-advantage-and-dual-eligibles-e44g18

Kevin Roche

Author Kevin Roche

The Healthy Skeptic is a website about the health care system, and is written by Kevin Roche, who has many years of experience working in the health industry through Roche Consulting, LLC. Mr. Roche is available to assist health care companies through consulting arrangements and may be reached at khroche@healthy-skeptic.com.

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