US Medicare Advantage plans offer a powerful new model for improving health care quality. These plans have found a way to engage the right set of clinicians around the objective of delivering improved value and have effectively realigned financial incentives to help realize improved outcomes.
Take the example of emergency room visits. About 4 in 10 of the patients in a fee-for-service matched sample visited the emergency room at least once in 2011. But for three progressively more managed delivery models, the figure drops—to below 2 in 10.
This decline in emergency room visits could reflect better management between acute episodes, better follow-up and scheduling of specialist visits, or better adherence on the part of patients to their treatment regimens.
There’s also a substantial reduction in the length of time that patients in the Medicare Advantage plan spend in the hospital—about a 19% lower average length of stay compared with the fee-for-service sample. Managed plans also have a lower percentage of readmissions, suggesting that the shorter hospital stays represent genuine improvements in the management of acute episodes of care.
