ARTICLE

Medicare Advantage value-based care demonstrates superior patient outcomes

senior at doctor appointment

  • Medicare Advantage (MA) patients in value-based care models, where providers are accountable for the quality and cost of care, experience better outcomes than those in fee-for-service arrangements, according to a newly published peer-reviewed study in JAMA Network Open

Why it matters

The findings demonstrate MA value-based care arrangements are associated with higher-quality clinical care and better health results than the traditional MA models. Comprehensive, value-based care includes performing preventive care screenings; referring patients to high-quality specialists, behavioral health practitioners and sites of care; and deploying best-in-class care management and at-home services where appropriate to proactively help keep people healthier over their lifetimes.


Details

The comprehensive study led by Dr. Ken Cohen, executive director of translational research at Optum, and conducted in partnership with researchers and physicians from America’s Physician Groups and Harvard University, compared two groups of MA enrollees. One group received care in value-based MA arrangements and another group received care via fee-for-service MA.

  • This study analyzed the care delivered to more than 1 million enrollees during the 2019 measurement year.
  • The results were examined across 20 care measures spanning four major categories: hospital inpatient care; care received in hospital emergency departments; avoiding hospitalization due to various diseases; and outpatient care.
     

By the numbers

Compared to patients in fee-for-service Medicare Advantage, those in value-based care arrangements were:

  • Up to 22% less likely to be admitted to the hospital for care measures including chronic conditions such as diabetes, high blood pressure, chronic obstructive pulmonary disease (COPD) or asthma, and heart failure.
  • 15% less likely to use high-risk medications that can cause serious adverse effects if used incorrectly or in combination with other medications.
  • 13% less likely to be admitted to a hospital within 30 days of being discharged from a prior hospital stay.
  • 9% less likely to be admitted to the hospital overall.
  • 9% less likely to visit hospital emergency departments.
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The big picture

Medicare Advantage value-based care arrangements deliver exceptional experiences and meaningful results for patients and providers alike, including a team-based approach to practicing medicine and improved clinical quality across multiple measures.

UnitedHealth Group is leading the transition from a volume-oriented, transaction-based system to a value-based care system that rewards high-quality, comprehensive and proactive care, and is proven to drive better health outcomes at a lower cost. Our focus on advancing value-based care reflects our commitment to helping create a future where every person has access to safe, high-quality, affordable health care and a modern, high-performing health system that reduces disparities, improves outcomes and lessens the burden of disease.
 


“These results demonstrate physician groups in accountable relationships with MA plans develop highly effective solutions for comprehensive patient care,” Cohen said.  “Because these plans incentivize physician groups based on quality outcomes and total cost of care, they have more resources to devote to preventive care and to provide intensive case management programs, behavioral health care and pharmacy services, among other interventions. Ultimately, this means patients experience better coordinated care and better health outcomes.” 
 

Go deeper

Read full study in JAMA Network Open

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