AHIP Study: Medicare Advantage Provides Better Care Than FFS Medicare

The AHIP study analyzed hospital admissions in California and Nevada compiled by AHRQ and compared utilization rates among enrollees in Medicare Advantage plans and in Medicare. AHIP says their study factored in age, sex, and 70 Hierarchical Condition Categories that are used in Medicare risk adjustment.

AHIP said the AHRQ data shows that:

• Hospital days were reduced by 30% in California and 23% in Nevada for Medicare Advantage beneficiaries, when compared with traditional Medicare enrollees.
• Medicare Advantage readmissions in the same quarter for the same condition were 15% less often in California and 33% less often in Nevada compared to Medicare.
• In both states, Medicare Advantage seniors were 6% less likely than seniors in Medicare to be admitted to the hospital for conditions described by AHRQ as "potentially avoidable," such as dehydration, urinary tract infection, or uncontrolled diabetes.

AHIP says the ARHQ data also found that Medicare Advantage seniors with chronic conditions in California and Nevada:

• Spent an average of 18% fewer days in the hospital than seniors in Medicare
• Had an average of 27% fewer visits to the emergency room than those seniors in Medicare
• Experienced a 42% lower rate of hospital re-admissions than those seniors in Medicare
• Had avoidable admissions that were 13% lower than those Medicare

ARHQ officials did not dispute the AHIP report, and said they had found similar results on preventable admissions for 13 states. However, the agency added its latest research—which is still under review—did not find the same favorable results for Medicare Advantage enrollees as in other studies.

ARHQ also noted that several studies show Medicare Advantage plans don't follow the same random selection process that is used for traditional Medicare enrollees, making any accounting for risk variability difficult.

Robert Zirkelbach, spokesman for AHIP, says California and Nevada was chosen because "Those are the only states that have the data publicly available where you can actually track patient readmissions. We are trying to see if we can get into other states. Right now, California has historically had some of the best data sets in the nation to allow these analyses.

"We are going to continue to try to get as much data as we can nationally."