This insight is crucial for skilled nursing facilities to understand how different Medicare plans impact patient care quality and utilization, which can inform strategies to improve patient outcomes and satisfaction.
The growing role of Medicare Advantage in the Medicare program and the changing demographics of Medicare Advantage enrollees have given rise to an interest in how well private plans serve their enrollees relative to traditional Medicare. To answer this question, we build on a previous review of research by examining 62 studies published since 2016 that compare Medicare Advantage and traditional Medicare based on measures of beneficiary experience, affordability, service utilization, and quality.
We found few differences between Medicare Advantage and traditional Medicare that are supported by strong evidence or have been replicated across multiple studies. Both Medicare Advantage and traditional Medicare beneficiaries reported similar rates of satisfaction with their care and overall measures of care coordination. Medicare Advantage outperformed traditional Medicare on some measures, such as use of preventive services, having a usual source of care, and lower hospital readmission rates. However, traditional Medicare outperformed Medicare Advantage on other measures, such as receiving care in the highest-rated hospitals for cancer care or in the highest-quality skilled nursing facilities and home health agencies. Additionally, a somewhat smaller share of traditional Medicare beneficiaries than Medicare Advantage enrollees experienced a cost-related problem, mainly due to lower rates of cost-related problems among traditional Medicare beneficiaries with supplemental coverage. Several studies found lower use of post-acute care among Medicare Advantage enrollees but were inconclusive as to whether that was associated with better or worse outcomes. Findings related to the use of other health care services, including hospital care and prescription drugs, and condition-specific quality of care measures varied – likely due to differences in data and methodology across studies.
Ochieng, N., & Biniek, J. F. (2022, September 16). Beneficiary Experience, Affordability, Utilization, and Quality in Medicare Advantage and Traditional Medicare: A Review of the Literature | KFF. KFF. https://www.kff.org/medicare/report/beneficiary-experience-affordability-utilization-and-quality-in-medicare-advantage-and-traditional-medicare-a-review-of-the-literature/
A review of 62 studies finds few big differences between traditional Medicare and Medicare advantage on a variety of measures | KFF. (2022, September 16). KFF. https://www.kff.org/medicare/press-release/a-review-of-62-studies-finds-few-big-differences-between-traditional-medicare-and-medicare-advantage-on-a-variety-of-measures/
Improve Medicare Advantage reimbursements with payer contract management that puts payer rules in the hands of clinicians & billers.
