MA plans show lower readmissions than tradition FFS
WASHINGTON – Research by America's Health Insurance Plans (AHIP) and healthcare data company MedAssurant shows that Medicare Advantage (MA) managed care plans can reduce 30-day hospital readmission rates by as much as 20 percent compared to traditional Medicare fee-for-service plans (FFS).
The new study "Hospital Readmission Rates in Medicare Advantage Plans" published in The American Journal of Managed Care, sought to compare data of Medicare Advantage managed care plans with an April 2009 study by Stephen Jencks and colleagues that showed 30-day readmission rates of 19.6 percent within Medicare's traditional FFS program.
Using data from 2006-2008, the study was able to show an estimated readmission rate of 14.5 percent over the period and that risk-adjusted rates under MA managed care plan were from 13 percent to 20 percent lower than for FFS patients.
According to Jon Bumbaugh, director of statistics and actuarial services at MedAssurant, and a co-author of the study, the new research was intended to add to the field of readmissions research, including two that used government Medicare data – the 1984 Andersen-Steinberg study and the 2009 research by Jencks et al.
"But those studies only looked at fee-for-service data," said Bumbaugh. "What we wanted to do here was to see what the readmission rates are in Medicare when you look at managed care."
In order to do that, and set a benchmark against which the managed care figures could be compared, the research team looked to replicate the work that had been done in the other studies in FFS and to use the same data analysis methods.
For the MA managed care information, the team mined MA data from MedAssurant's Medical Outcomes Research for Effectiveness and Economics (MORE2) database, which the company says currently includes data from more than 5.7 billion individual medical encounters. In total, the study of MA data included approximately 5.6 million observations (enrollee-years) and 2.4 million individuals in the three-year (2006-2008) period from 11 MA plans.
"The basic results were quite dramatic," said Bumbaugh. "For the three years studied, the (30-day readmission) rates stayed at around 14.5 or 14.6 percent rate compared to the 19.6 percent rate of the Jencks study."
According to Jeff Lemieux, senior vice president, Center for Health Policy and Research at AHIP, who also co-authored the study, the research team got in touch with both Jencks and Andersen from previous studies to let them know the results.
"Dr. Jencks said 'well your work has just begun, now that you have the data, you need to study it very closely,'" said Lemieux. In addition, Andersen told the team that he also had data from the same 2006-2008 time period for Medicare FFS.
An apples-to-apple comparison of this new FFS data showed 30-day readmission rates of 18.4 percent, still significantly higher than the managed care findings.
The researchers did say it was important to note that the study did not delve into any specific reasons why the manage population's readmission rates were lower, though it was easy to draw assumptions, if not direct connections.
"These plans are using innovative tools to expand patient access to urgent care centers, arranging for phone calls and important follow-up, offering intensive case management to help patients stay in their homes which is crucial to managing their care at low cost and improving quality," said Karen Ignagni, president and CEO of AHIP, in an introduction to the findings at AHIP's Policy Summit in March.
For MedAssurant, the research work with AHIP was not so much about proving the applicability of the MORE2 database, but about adding to the base of knowledge in the industry with an influential partner.
"We are strong advocates of the utilization of actual data in informing a more intelligent healthcare environment," said Keith Dunleavy, MD, CEO of MedAssurant. "To have an important player like AHIP come to us and say they would like the actual data to help understand the marketplace, we were delighted to partner with them."