Medicare managed care reduced preventable hospitalizations in 2004 more than fee-for-service Medicare

Research Activities, August 2012, No. 384

Medicare beneficiaries enrolled in Medicare Advantage (MA) managed care plans in three States during 2004, when HMOs dominated the market in those States, had lower risk of preventable hospitalizations than Medicare fee-for-service (FFS) beneficiaries. Preventable hospitalizations are those that can typically be avoided by quality primary care. These findings show the benefit of care coordination provided in Medicare HMOs and suggest their added value to the quality of primary care for the elderly in reducing preventable hospitalizations, note Jayasree Basu, Ph.D., M.B.A., of the Agency for Healthcare Research and Quality (AHRQ), and Lee Rivers Mobley, Ph.D., of Research Triangle Institute International.

The researchers used 2004 hospital discharge files from AHRQ's Healthcare Cost and Utilization Project State Inpatient Databases. They found that MA beneficiaries in California, Florida, and New York had 22 percent, 16 percent, and 9 percent fewer preventable hospital admissions, respectively, than FFS beneficiaries. The evidence was mixed about the specialty referrals provided by MA plans. For example, the relative risk of hospitalization for referral-sensitive conditions versus marker conditions (urgent conditions insensitive to primary care) was 37 percent higher in New York and 41 percent higher in Florida for MA beneficiaries compared to FFS beneficiaries, but was 13 percent lower in California for MA than FFS beneficiaries. These findings suggest that maturity of MA plans and higher use control mechanisms are probably important for controlling such non-urgent hospital admissions.

More details are in "Medicare managed care plan performance: A comparison across hospitalization types," by Drs. Basu and Mobley in the Medicare & Medicaid Research Review 2(1), pp. E1-E20, 2012. Reprints (Publication No. 12-R061) are available from the AHRQ Publications Clearinghouse.


Page last reviewed August 2012
Internet Citation: Medicare managed care reduced preventable hospitalizations in 2004 more than fee-for-service Medicare: Research Activities, August 2012, No. 384. August 2012. Agency for Healthcare Research and Quality, Rockville, MD.