Medicare Advantage’s Two-Sided Risk Model Associated With Reduced Acute Care Use

Value-based payment models can significantly lower acute care usage among Medicare beneficiaries, suggested a study of nearly 500,000 Medicare Advantage members published last month in JAMA Network Open. The study, which analyzed data collected between December 2017 and January 2019, was led and reviewed by the Humana Healthcare Research Human Subject Protection Office. (Humana is the second-largest MA insurer in the U.S). MA beneficiaries participating in two-sided risk models had lower rates of hospitalizations, observation stays and emergency department visits compared with fee-for-service (FFS) Medicare enrollees. This effect was particularly striking in avoidable acute care use — the two-sided risk model was associated with a 15.6% reduction in avoidable hospitalizations. Researchers noted a lack of significant differences between FFS and upside-only risk models, which “suggests that downside financial risk may play a key role in effective value-based payment arrangements.”

© 2022 MMIT
Carina Belles

Carina Belles

Carina is a reporter at AIS, specializing in public sector data research, trend analysis and infographics. She holds a Bachelor of Science in Journalism from Ohio University, joining AIS shortly after graduating in 2014.

Related Posts

pharmacist-at-computer
March 10

Industry Trade Groups Sound Off About Proposed DIR Overhaul

READ MORE
us-capitol-and-flag
March 17

In Latest Report to Congress, MedPAC Maintains MA Plans Are Overpaid

READ MORE
people-shaking-hands
February 18

Experts Discuss Pros, Cons of Risk-Based Payment in Primary Care

READ MORE

GAIN THERAPEUTIC AREA-SPECIFIC INTEL TO DRIVE ACCESS FOR YOUR BRAND

Sign up for publications to get unmatched business intelligence delivered to your inbox.

subscribe today