Medicare Advantage health maintenance organization (HMO) plans might be succeeding at discouraging unnecessary use of medical care.
Bruce Landon, a researcher at Harvard Medical School, and other researchers make that argument in a paper published in Health Affairs, an academic journal that covers health care delivery and health care finance systems.
Landon and his colleagues analyzed claims data for Medicare Advantage HMO plan enrollees and traditional Medicare defined benefit plan enrollees from 2003 through 2009.
The researchers found that Medicare Advantage HMO enrollees were about 25 percent to 35 percent less likely to go to an emergency room over the period studied and that they spent about 20 percent to 25 percent fewer days getting medical care in the hospital as hospital inpatients.
The Medicare Advantage HMO plans started out with significantly fewer inpatient hospital surgical days per patient in 2003, but, in 2007 and 2009, inpatient surgical day rates were similar for the Medicare Advantage HMO plans and the traditional Medicare plans, the researchers said.
The Medicare Advantage HMO enrollees also got more heart bypass grafts, the researchers said.
“Proponents of managed care have argued that integrated health plans can deliver care more rationally than traditional fee-for-service care, using their ability to tailor their provider networks to the needs of their population and to impose preapproval requirements and utilization review to limit the use of procedures,” the researchers said.
The 2003-2009 claims data analysis seems to support the idea that HMOs might be decreasing use of medical care, the researchers said.