Avalere Health on behalf of the Better Medicare Alliance issued a report updating a 2018 analysis that compares demographic and clinical characteristics of Medicare Advantage (MA) and FFS beneficiaries. The study uses 2019 claims and demographic data to reach its conclusions with a focus on three key diagnoses – hypertension, hyperlipidemia and/or diabetes. Demographically, MA enrollees are more racially and ethnically diverse (28% in MA vs. 12.5% in FFS) and have more social risk factors. The report notes that MA enrollees had lower rates of inpatient utilization and ER visits and slightly higher rates of physician visits. MA enrollees who did incur an inpatient stay stayed there on average 2 days longer than their FFS counterparts. On this latter point, the report doesn’t address whether the long length of stay was the result of an inability of the MA plan to find a post-acute care provider to accept the individual. Also of note, longer hospital stays don’t result in higher spending for the plan since hospitals are paid essentially a flat rate by diagnosis. The report also finds that MA enrollees with the 3 studied diagnoses had lower overall healthcare spending. In this case, we must question whether this lower aggregate spending is the result of plans paying providers less per unit of service and/or reducing the number of units of services delivered. MA enrollee per member per month (PMPM) spend for MA enrollees in the subgroups ranged was roughly 70% of FFS spending. Skilled Nursing Facilities and Home Health agencies report MA plans paying them roughly 60-80% of FFS rates. Regardless of amount spent and changes in utilization patterns, the report finds that quality was similar between MA and FFS.
