News: Medicare Advantage has lower utilization and higher clinical care quality, study shows

According to a recent study conducted by Health Affairs, Medicare Advantage (MA) outperforms traditional Medicare in terms of clinical care quality, despite the fact that MA is used far less by patients. The study compared 2010 clinical quality performance indicators to those of 2017 and found that for almost all measures MA’s performance was superior, including in health maintenance organizations (HMO) and preferred provider organizations (PPO).

Researchers also noted that, in 2010 and 2017, MA HMOs performed the same as or better than Medicare in all measures except osteoporosis, while PPOs also did so on everything except one patient-reported quality measure The quality performance measures were taken from the CMS Healthcare Effectiveness Data and Information Set.

In its discussion of the study, Healthleaders reported that, compared with traditional Medicare in 2017, MA HMOs experienced 30% fewer emergency department visits, about 10% fewer elective hip and knee replacements, and almost 30% fewer back surgeries.

It concluded its report by noting that though MA delivers higher quality of care, a claim validated by the record increase of 2.7 million members this year, the plans have been under scrutiny for receiving billions of dollars in overpayment due to claims of incentivized upcoding.

“As policymakers consider alternatives to address potential overpayments in Medicare Advantage,” researchers of the study stated, “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.”

Editor’s note: To read HealthLeaders’ coverage of this story, click here. To read the MA study, click here.