Medicare Advantage Plan Provides Model for Improving Care for Patients with Diabetes

For Immediate Release
January 9, 2012

Robert Zirkelbach

New Study in Health Affairs provides further evidence of the value Medicare Advantage provides compared to FFS Medicare;
Patients with diabetes had more primary care visits and fewer hospital admissions and readmissions compared to FFS Medicare 

Washington, D.C. – Seniors with diabetes in a Medicare Advantage special-needs plan had more primary care physician office visits and fewer hospital admissions and readmissions than beneficiaries in fee-for-service (FFS) Medicare, according to a new study in the January issue of Health Affairs sponsored by XLHealth Corporation and conducted in partnership with America’s Health Insurance Plans (AHIP).

Preventing avoidable hospital admissions and readmissions protects patients from the risks associated with inpatient settings, such as infection, and is an indication that patients are getting the care and services they need on an outpatient basis to stay healthy and avoid complications that can lead to hospital readmissions. Identifying improvement in this area as a national priority, the U.S. Department of Health & Human Services’ Partnership for Patients set a goal to reduce preventable hospital readmissions by 20 percent by the end of 2013.

According to the Health Affairs study, people with diabetes in the special-needs plan had seven percent more primary care physician office visits; nine percent lower hospital admission rates; 19 percent fewer hospital days; and 28 percent lower hospital readmission rates compared to patients in FFS Medicare. The analysis also found that the results for nonwhite beneficiaries were similar to all beneficiaries enrolled in the plan, suggesting that the plan is effective in addressing ethnic and racial disparities in health care.

“Health plans have played a leadership role in bringing programs to the delivery system that are helping patients get appropriate follow-up care and avoid preventable hospital readmissions and emergency room visits,” said Karen Ignagni, President and CEO of AHIP.

Chronic Condition Special Needs Plans (C-SNPs) are a type of Medicare Advantage plan authorized under the 2003 Medicare Modernization Act to provide coordinated health care to people with selected chronic health conditions. Such plans are distinguished from other Medicare Advantage plans in that they are disease specific; they create a model of care around specified diseases and enroll only beneficiaries with those conditions.

The new study, “Medicare Advantage Chronic Special Needs Plan Boosted Primary Care, Reduced Hospital Use Among Diabetes Patients,” examines the model of care used by the largest Medicare Advantage chronic special-needs plan, Care Improvement Plus, and compares utilization rates among its members with diabetes in Arkansas, Georgia, Missouri, South Carolina and Texas with those of similar beneficiaries enrolled in fee-for-service Medicare in the same five states. Care Improvement Plus’ Model of Care emphasizes direct contacts with patients to help identify gaps in care and promote primary and preventive health care, including periodic home visits with plan clinicians.

The article states that “CMS may be able to adapt or replicate some of the methods used by the C-SNP program studied here to improve Medicare beneficiaries’ care and outcomes – not only for minority patients with diabetes, but potentially for beneficiaries with a broad range of chronic diseases.”

Click here to access a copy of the full Health Affairs article. 

The Health Affairs study follows a series of studies by AHIP researchers comparing patterns of care among patients with Medicare Advantage coverage and in the FFS Medicare program. The most recent report, based on an analysis of hospital discharge datasets provided by the Agency for Healthcare Research and Quality (AHRQ) as well as state discharge data acquired directly from the states of Pennsylvania and Texas, estimated risk-adjusted readmission rates were about 27-29 percent lower in Medicare Advantage than Medicare FFS per enrollee, 16-18 percent lower per person with an admission, and14-17 percent lower as measured per hospitalization.

AHIP has also entered into a partnership with MedAssurant, Inc., a leading health care research and solutions provider, to further study readmission rates among seniors in Medicare Advantage and fee-for-service Medicare. MedAssurant has a large dataset uniquely suited for this purpose. The findings have yielded similar results to previous AHIP reports and have been submitted to a medical journal for publication.

A recent AHIP publication, Innovations in Reducing Preventable Hospital Admissions, Readmissions, and Emergency Room Use, provides company specific examples of the types of programs and services that health plans have implemented to reduce preventable hospital admissions, readmissions, and emergency room visits. Examples of the types programs include the following:

  • Expanding patient access to urgent care centers, after-hours care, and nurse help lines give patients safe alternatives to emergency rooms for non-emergency care.
  • Arranging for phone calls and, in some cases, in-home visits by nurses and other professionals to make sure that follow-up appointments are kept, medications are being taken safely, care plans are being followed, medical equipment is delivered, and home health care is being received.
  • Offering intensive case management to help patients at high risk of hospitalization access the medical, behavioral health, and social services they need.
  • Arranging for home visits by multidisciplinary teams of clinicians, who provide comprehensive care, teach patients and their caregivers how to take medications correctly, and link families with needed community resources.
  • Revamping physician payment incentives to promote care coordination and improved health outcomes.

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