Studies on Hospital Readmissions, Featuring Health Plan Innovations and Comparisons of Medicare Advantage (MA) and Medicare’s Traditional FFS Program
Hospital Readmission Rates in Medicare Advantage Plans
February 2012—American Journal of Managed Care (PDF; Appendices; Press Release)
Based on a large sample of administrative claims data, this study measured 30-day readmission rate for hospitalized Medicare Advantage (MA) patients of 14.5% (per admission) in the 2006-2008 period. After adjustments for readmission risk and disability entitlement status, the MA readmission rate was about 13% to 20% lower than that in Medicare’s traditional fee-for-service (FFS) program. Benchmark measurements of readmission rates among MA patients can help provide an impetus for additional reductions in both MA and FFS Medicare.
Medicare Advantage Chronic Special Needs Plan Boosted Primary Care, Reduced Hospital Use Among Diabetes Patients
January 2012—Health Affairs (Abstract; PDF; Full Text; Press Release)
This case study examines the model of care used by Medicare’s largest Chronic Special Needs Plan (C-SNP), Care Improvement Plus, and compares utilization rates among its diabetes patients with those of other beneficiaries enrolled in fee-for-service Medicare in the same five states. This C-SNP plan emphasizes direct contacts with patients to help identify gaps in care and promote primary and preventive health care. The comparative analysis indicates that people with diabetes in the special-needs plan—particularly nonwhite beneficiaries—had lower rates of hospitalization and readmission than their peers in fee-for-service Medicare.
Working Paper: Simple Methods of Measuring Hospital Readmission Rates
This working paper summarizes the various methods used by AHIP for computing readmission rates in a series of publications over the last several years.
Innovations in Patient Safety
This report highlights 16 health plans’ efforts to prevent healthcare-acquired conditions, help patients transition smoothly from hospital to home, and manage chronic conditions effectively to avoid complications and preventable readmissions.
Using AHRQ’s 'Revisit' Data to Estimate 30-Day ReadmissionRates in Medicare Advantage and the Traditional Fee-for-Service Program
New 30-day readmission rate calculations using “revisit” data from AHRQ show consistently lower rates among Medicare Advantage patients.
Innovations in Reducing Preventable Hospital Admissions, Readmissions, and Emergency Room Use
A review of health plan programs to revitalize primary care, improve care coordination, and help patients avoid adverse health events. View highlights of this report.
Working Paper: Using State Hospital Discharge Data to Compare Readmission Rates in Medicare Advantage and Medicare’s Traditional Fee-for-Service Program
The latest in a series of studies comparing MA and FFS enrollees’ health care outcomes uses new data from nine states’ publicly available hospital discharge data from AHRQ and the states of Texas and Pennsylvania. Reductions in risk-adjusted hospital readmission rates averaged 14-29 percent among Medicare Advantage enrollees, depending on the readmission rate measure used, compared with FFS enrollees.
View a summary of this report.
Working Paper: Comparisons of Utilization in Two Large Multi-State Medicare Advantage HMOs and Medicare Fee-for-Service in the Same Service Areas
This report is the second in a series of working papers comparing patterns of care among patients with Medicare Advantage (MA) coverage and in Medicare’s traditional fee-for-service (FFS) program. The comparisons presented in this report are based on data from two large, multi-state MA HMO plans and Medicare’s FFS 5 percent sample claims files in the same operating areas. The utilization measures include hospital admissions and days, re-admissions, “potentially avoidable” admissions, as well as outpatient, emergency room (ER), and office visits.
View slides for this report.
Reductions in Hospital Days, Re-Admissions, and Potentially Avoidable Admissions among Medicare Advantage Enrollees in California and Nevada, 2006
Seniors in Medicare Advantage spent fewer days in a hospital, were subject to fewer hospital re-admissions, and were less likely to have "potentially avoidable" admissions for common conditions ranging from uncontrolled diabetes to dehydration, on a risk-adjusted basis, according to a new analysis of publicly available data from AHRQ. View slides for this report.
Working Paper: A Preliminary Comparison of Utilization Measures among Diabetes and Heart Disease Patients in Eight Regional Medicare Advantage Plans and Medicare Fee-for-Service in the Same Service Areas
This report describes a new effort to compare patterns of care among patients in Medicare Advantage (MA) plans and in Medicare’s traditional fee-for-service (FFS) program. The utilization measures include hospital admissions and days, re-admissions, “potentially avoidable” admissions, as well as outpatient, emergency room (ER), and office visits. Health status data include markers for 70 claims-based diagnosis code groupings. Revised September 2009 – View slides from this report.
Trends and Innovations in Chronic Disease Prevention & Treatment: An Update on Medicare Advantage Plans
An overview of key trends in chronic care, highlighting Medicare Advantage plans' recent innovations.