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Is Medicare Advantage an Advantage?

Posted Sep 23 2009 10:46pm
It would appear the Medicare Advantage programs, Medicare HMOs if you will, actually provide better care. Health plan industry trade group America's Health Insurance Plans has released a study concluding that Medicare Advantage plans may be doing a better job of controlling costs and preventing harm to patients.

AHIP looked at hospital admissions in California and Nevada. This risk-adjusted data concluded that Medicare Advantage enrollees had significantly lower inpatient days per patient, lower readmission rates and lower rates of avoidable hospital admissions.

Researchers concluded that for a group of 13 potentially-avoidable admissions, risk-adjusted Medicare Advantage patients had 6 percent lower rates of avoidable admissions in both states.

As someone who used to work for a Medicare Advantage affiliated physician organization, I am not endorsing enrolling in these programs over traditional Medicare. I will say that my experience in this industry was from a unique vantage point. I worked for a physician organization that aggressively managed the health care of patients. That included having our own medical director, physicians ownership and patient advocates making sure that patients took advantage of all that the health plan had to offer. Of course we were doing right by the patient and it had an economic benefit as well. The government paid us so much to take care of each member. If we did it for less we kept more. So it made economic sense and good patient sense.

Maybe a public run option would look at Medicare Advantage as a program to possibly emulate.
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