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AHIP: Medicare Advantage Patients Do Better

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America’s Health Insurance Plans says the extra services its members provide for Medicare beneficiaries through the Medicare Advantage program really do improve patients’ health.

President Obama and other Democrats argued during the recent health reform summit in Washington that the Medicare Advantage program – which gives private carriers a chance to offer alternatives to the basic Medicare plan, rather than Medicare supplement insurance products that simply fill in the many the gaps in Medicare coverage – costs more than the traditional Medicare plan without doing much to improve participants’ health. Medicare Advantage plans usually offer lower deductibles, extra coverage for preventive care services and care coordination in exchange for members agreeing to use in-network care providers.

The Obama administration has been pushing for a shift back toward traditional Medicare – which imposes relatively high deductible requirements on enrollees who do not pay extra for Medicare supplement insurance – while supporting requirements that plans offered to working-age patients through a proposed health insurance exchange system provide richer benefits, with fewer gaps than many individual health insurance policies now leave in coverage.

AHIP, Washington, has responded to the Democrats’ allegations about Medicare Advantage plans with a “fact check” report full of statistics suggesting that comprehensive Medicare Advantage can help participants live longer, more comfortable lives than the less comprehensive traditional Medicare plans do.

AHIP analysts originally published the statistics in October 2009. They drew on 2006 California and Nevada hospital admissions data compiled by the federal Agency for Healthcare Research and Quality.

After adjusting for factors such as age, sex, and medical condition, the analysts found that Medicare Advantage plan enrollees in California spend 30% fewer days in the hospital than patients in traditional Medicare plans do.

In Nevada, Medicare Advantage plan enrollees spend 23% fewer days in the hospital than traditional Medicare plan enrollees do, the analysts report.

Similarly, Medicare Advantage enrollees were re-admitted to the hospital in the same quarter for the same condition 15% less often than traditional Medicare enrollees in Nevada and 33% less often than traditional Medicare enrollees in California.

In both California and Nevada, Medicare Advantage enrollees were 6% less likely than traditional Medicare enrollees to be admitted to the hospital for “potentially avoidable” conditions such as dehydration, urinary tract infection or uncontrolled diabetes, the AHIP analysts report.

“A recent comprehensive study on [traditional plan fee-for-service plan] readmissions noted that in half of the re-admissions studied among FFS patients, there was no physician contacted billed to Medicare prior to re-admission,” the AHIP analysts write in the October 2009 commentary. “We assume that the [Medicare Advantage] plans are able to lower re-admission rates precisely because of their emphasis on discharge planning and coordinated care follow-up.”

An earlier AHIP study found that Medicare Advantage enrollees had 27% fewer emergency room visits than traditional Medicare plan enrollees did and spent 18% fewer days in the hospital, the analysts report.

AHIP also has come out with a commentary reminding policymakers about the sharp cuts in Medicare alternative plan enrollment that occurred in the late 1990s, when Congress less tried the shift the country back toward relying on traditional Medicare and Medicare supplement insurance.