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Medicare Advantage Chronic Special Needs Plan Boosted Primary Care, Reduced Hospital Use Among Diabetes Patients
January 2012—Health Affairs (Abstract; PDF; Full Text; Press Release)
This case study examines the model of care used by Medicare’s largest Chronic Special Needs Plan (C-SNP), Care Improvement Plus, and compares utilization rates among its diabetes patients with those of other beneficiaries enrolled in fee-for-service Medicare in the same five states. This C-SNP plan emphasizes direct contacts with patients to help identify gaps in care and promote primary and preventive health care. The comparative analysis indicates that people with diabetes in the special-needs plan—particularly nonwhite beneficiaries—had lower rates of hospitalization and readmission than their peers in fee-for-service Medicare.
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08.25.2011
Innovations in Patient Safety
This report highlights 16 health plans’ efforts to prevent healthcare-acquired conditions, help patients transition smoothly from hospital to home, and manage chronic conditions effectively to avoid complications and preventable readmissions.
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10.12.2010
Using AHRQ’s 'Revisit' Data to Estimate 30-Day Readmission Rates in Medicare Advantage and the Traditional Fee-for-Service Program (Full Report)
New 30-day readmission rate calculations using “revisit” data from AHRQ show consistently lower rates among Medicare Advantage patients.
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06.07.2010
Innovations in Reducing Preventable Hospital Admissions, Readmissions, and Emergency Room Use (Full Report; Highlights)
A review of health plan programs to revitalize primary care, improve care coordination, and help patients avoid adverse health events.
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05.14.2010
Working Paper: Using State Hospital Discharge Data to Compare Readmission Rates in Medicare Advantage and Medicare’s Traditional Fee-for-Service Program (Full Report; Summary)
The latest in a series of studies comparing MA and FFS enrollees’ health care outcomes uses new data from nine states’ publicly available hospital discharge data from AHRQ and the states of Texas and Pennsylvania. Reductions in risk-adjusted hospital readmission rates averaged 14-29 percent among Medicare Advantage enrollees, depending on the readmission rate measure used, compared with FFS enrollees.
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12.11.2009
Working Paper: Comparisons of Utilization in Two Large Multi-State Medicare Advantage HMOs and Medicare Fee-for-Service in the Same Service Areas (Full Report; Slide)
This report is the second in a series of working papers comparing patterns of care among patients with Medicare Advantage (MA) coverage and in Medicare’s traditional fee-for-service (FFS) program. The comparisons presented in this report are based on data from two large, multi-state MA HMO plans and Medicare’s FFS 5 percent sample claims files in the same operating areas. The utilization measures include hospital admissions and days, re-admissions, “potentially avoidable” admissions, as well as outpatient, emergency room (ER), and office visits.
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10.23.2009Revised
Reductions in Hospital Days, Re-Admissions, and Potentially Avoidable Admissions Among Medicare Advantage Enrollees in California and Nevada, 2006 (Full Report; Slides)
Seniors in Medicare Advantage spent fewer days in a hospital, were subject to fewer hospital re-admissions, and were less likely to have "potentially avoidable" admissions for common conditions ranging from uncontrolled diabetes to dehydration, on a risk-adjusted basis, according to a new analysis of publicly available data from AHRQ.
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09.01.2009Revised
Working Paper: A Preliminary Comparison of Utilization Measures Among Diabetes and Heart Disease Patients in Eight Regional Medicare Advantage Plans and Medicare Fee-for-Service in the Same Service Areas (Full Report; Slides)
This report describes a new effort to compare patterns of care among patients in Medicare Advantage (MA) plans and in Medicare’s traditional fee-for-service (FFS) program. The utilization measures include hospital admissions and days, re-admissions, “potentially avoidable” admissions, as well as outpatient, emergency room (ER), and office visits. Health status data include markers for 70 claims-based diagnosis code groupings. (Revised September 2009)
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