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AHIP: Medicare Advantage Plans Cut Enrollee Re-Hospitalization

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Medicare Advantage plan practices may be reducing the likelihood that an enrollee will be re-admitted to the hospital by as much as 14% to 29%, according to America’s Health Insurance Plans.

AHIP today reported that conclusion in an analysis of Medicare Advantage plan and traditional Medicare fee-for-service program hospital readmission rates.

AHIP looked at Medicare program data from 9 states, then determined what percentage of Medicare Advantage plan enrollees discharged from a hospital were rehospitalized within 30 days and what percentage were rehospitalized within 90 days.

About 20% of the patients enrolled in the traditional Medicare fee-for-service program were rehospitalized within 30 days, and 34% of the Medicare FFS patients were rehospitalized within 90 days, AHIP says, citing figures published in the New England Journal of Medicine.

About half of the Medicare FFS patients who were rehospitalized within 30 days did not have a physician visit between the time of discharge and the time of rehospitalization, and that statistic suggests that many of the patients may have returned to the hospital because of a lack of follow-up care, AHIP says.

Medicare Advantage plan 30-day readmission rates were about 12% to 14% — 27% to 29% lower than the Medicare FFS readmission rates for all enrollees — and per-enrollee readmission rates were about 16% to 18% lower, AHIP says.

Medicare Advantage plans may be lowering readmission rates by providing more access to after-hours care and nurse help lines, arranging for telephone calls for many patients and in-home nurse visits for some, and providing the services to help get enrollees to medical appointments, AHIP says.


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