A report by the Kaiser Family Foundation reveals that Medicare HMOs perform better than traditional Medicare in providing preventive services and using resources more conservatively, at least through 2009. Two studies found that Medicare PPOs performed better than traditional Medicare on some metrics (particularly mammography rates). HMOs performed better than PPOs. These studies were conducted before changes made by the Affordable Care Act (ACA) to improve coverage of preventive services under traditional Medicare.
There is some evidence that relatively low cost-sharing (through Medicare HMOs or through Medicare with supplemental coverage), may result in earlier diagnoses of some cancers compared to traditional Medicare alone. Treatment patterns for some cancers may differ between Medicare HMOs and traditional Medicare, but studies do not show that it affects patient outcomes.
Medicare beneficiaries in HMOs are less likely to be hospitalized for a potentially avoidable admission than beneficiaries in traditional Medicare, according to six studies of beneficiaries represented by the Alliance of Community Health Plans (ACHP). Four of these studies rely on data before 2006, and reflect HMO experiences in mature markets. Performance varies substantially among Medicare Advantage plans, even among those of the same plan type. More established HMOs with integrated delivery systems tend to perform better.
On the other hand, beneficiaries rate traditional Medicare higher in quality and access, such as care and plan rating, though one study suggests that the difference may be narrowing for the average beneficiary. Traditional Medicare is much more popular among beneficiaries who are sick. It is not yet possible to assess performance after the implementation of the ACA’s Medicare Advantage payment changes. Except for hospice care, none of the 40 studies comparing Medicare Advantage to traditional Medicare rely on data from 2010 or later.
Contact me for more information,
Lorraine Nellis
lorraine@accesshealthins.com
760-727-9000
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