Performance was higher in Medicare Advantage (MA) health maintenance organizations (HMOs) and preferred provider organizations (PPOs).
Enrollees utilize Medicare Advantage at a lower rate than traditional Medicare, but the former has higher clinical quality performance, according to a study published in Health Affairs.
In a comparison of quality and utilization measures in MA and traditional Medicare in 2010 and 2017, researchers found clinical quality performance was higher in MA HMOs and PPOs in nearly all measures in both years.
Clinical quality performance was based on CMS Healthcare Effectiveness Data and Information Set (HEDIS) measures.
MA HMOs outperformed traditional Medicare in all nine measures in both years, aside from osteoporosis in 2010. In 2017, MA HMOs improved on nearly all seven measures and outperformed traditional Medicare on five of them.
MA PPOs, meanwhile, either kept pace or outpaced traditional Medicare on all but one patient-reported quality measure in both years.
In terms of utilization, MA HMOs experienced 30% fewer emergency department visits, approximately 10% fewer elective hip and knee replacements, and almost 30% fewer back surgeries than traditional Medicare in 2017. The differences were less noticeable with MA PPOs, but the utilization trends held true.
As MA continues to grow at a rapid pace, adding a record 2.7 million members this year, it is notable that the study suggests MA does deliver higher quality of care.
However, MA plans have been under scrutiny for receiving billions of dollars in overpayments, in large part due to incentivized upcoding. CMS has released its Medicare Advantage Risk Adjustment Data Validation final rule to recoup the overpayments, which payer groups claim will have the unintended effect of harming patients.
The study concluded: "As policymakers consider alternatives to address potential overpayments in Medicare Advantage, they should also consider the evidence that MA plans provide fewer services while also achieving equal or better quality performance relative to traditional Medicare on a broad array of measures."
Jay Asser is the CEO editor for HealthLeaders.
KEY TAKEAWAYS
A study compared quality and utilization measures across Medicare Advantage and traditional Medicare in 2010 and 2017.
The findings reveal that Medicare Advantage, despite being utilized less than traditional Medicare, had better clinical quality performance in HMOs and PPOs in nearly all measures in 2010 and 2017.