ARTICLE

Exploring the spillover effects of Medicare Advantage risk payment arrangements

March 26, 2025
  • In a new peer-reviewed paper published in the American Journal of Managed Care, findings show traditional Medicare patients cared for by physician groups operating under accountable, value-based care arrangements with Medicare Advantage (MA) plans have better health outcomes.

Why it matters

This study is the first to demonstrate that the advantages of value-based care can extend — or “spill over” — beyond MA patients to other Medicare recipients. These benefits include fewer hospitalizations for chronic illnesses, fewer emergency visits, more wellness visits, and better medication adherence.

Details

Researchers, including Optum Health’s Dr. Ken Cohen, studied nine large physician groups that provided care to over 1.4 million traditional Medicare patients between 2016 and 2019.

The study examined two groups of traditional Medicare patients. The first group was treated by doctors who frequently dealt with complex situations. The second group was a smaller, random sample (20%) of patients treated by all other doctors.

By the numbers

Traditional Medicare patients who benefited from Medicare Advantage value-based care practices were:

  • 10% less likely to have acute hospital admissions
  • 12% less likely to be readmitted within 30 days
  • 5% less likely to be prescribed high-risk medications
  • 9%-13% more likely to adhere to medications for hypertension, diabetes and high cholesterol
  • 21% less likely to use emergency departments, and 82% more likely to have annual wellness visits


“There is clear indication the superior care outcomes achieved by physician groups participating in at-risk MA payment arrangements for quality and costs ‘spill over’ to traditional Medicare patients who also benefit from a more coordinated and preventive care model. The results further validate that Medicare Advantage value-based care models are improving health outcomes across different patient populations.”

Dr. Ken Cohen | executive director, Translational Research, Optum Health


The big picture

The positive spillover effects benefiting traditional Medicare patients highlight the broader positive impact of accountable, value-based care Medicare Advantage arrangements.

Go deeper

Details: In this episode, Dr. Ken Cohen, executive director of Translational Research at Optum Health, discusses the impact of value-based care models on patient outcomes. 

He shares key findings from his recent research including:

  • How Medicare Advantage patients in value-based arrangements receive superior care.
  • How these benefits extend to traditional Medicare patients.

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