January 23, 2025
Contact: Erin Hemlin, Vice President of Communications, APG Email: ehemlin@apg.org
Tel: (202) 770-1901
Patients cared for by physician groups engaged in accountable relationships with Medicare Advantage plans experienced far fewer hospital admissions for common chronic conditions, as well as fewer emergency department visits and less-use of risky medications, according to a study published today in JAMA Network Open. The study is among the first to demonstrate a clear positive difference in patients’ outcomes when physician groups are fully accountable for the quality and costs of Medicare Advantage enrollees’ care, versus when medical groups are paid on a fee-for-service basis for caring for MA enrollees.
The study analyzed the care delivered to more than 1 million MA enrollees over three years (2016-2019) by 17 large physician groups, all of which are members of America’s Physician Groups, a national organization of medical groups committed to value-based, accountable health care. Researchers found that patient care differences occurred when the medical groups were in accountable partnerships with MA health plans versus when the groups were simply reimbursed for the care that they provided MA enrollees on a fee-for-service basis by MA plans. In the accountable relationships, medical groups were paid lump sums for each Medicare Advantage enrollee – and thus were “at risk” for the quality and costs of caring for patients and incentivized to make the best use of resources to keep patients as healthy as possible (see attached infographic).
Comparing the two groups of MA enrollees – those cared for under the accountable relationships, versus the others cared for by groups operating in conventional fee-for-service payment arrangements — the researchers examined results across 20 care measures. They found that patients cared for in accountable arrangements were
- 7 percent less likely to undergo hospital admissions overall
- 8-22 percent less likely to be admitted to the hospital for common chronic conditions, such as diabetes, high blood pressure, chronic obstructive pulmonary disease, and heart failure
- 7 percent less likely to visit hospital emergency departments, and 8.7 percent less likely to be admitted to hospitals from emergency departments
- 15 percent less likely to experience use of high-risk medications that can cause serious adverse effects or death if used incorrectly or in combination with other medications
“These results demonstrate that physician groups in accountable relationships with MA plans develop highly effective solutions for comprehensive patient care,” said the lead researcher on the study, Ken Cohen, MD, a longtime physician with APG member Optum Colorado Physician Group and executive director of translational research at Optum.
Because of the way these physician groups are paid by MA plans, he added, they have more financial resources to devote to preventive care and to provide intensive case management programs, behavioral health care, and pharmacy services, among other interventions. The lower hospitalization rates that result mean not only that patients are staying healthier, but also that they are benefiting from more efficient and personalized care, Cohen said.
“APG is proud of the results demonstrated by our member organizations, who care for approximately 1 in 3 Medicare Advantage patients nationwide,” said Susan Dentzer, president and chief executive officer of America’s Physician Groups. “Our member groups have pioneered in the creation of accountable relationships with MA plans in which they are at risk for quality and costs. We hope that these study results will help illuminate the fact that, at its best, Medicare Advantage can be a true partnership between physician groups and MA plans that can deliver superior results for patients.”
The rapidly growing Medicare Advantage program is not monolithic, Dentzer added, and the study results show that some arrangements between plans and provider groups clearly perform better than others. “We think policymakers can now use these results to encourage and reward more MA plans and provider groups to form these close partnerships and dramatically improve patient care,” she said.
APG has also created an infographic that explains the import of the study and its findings.
About America’s Physician Groups
APG’s approximately 360 physician groups comprise 170,000 physicians, as well as thousands of other clinicians, providing care to nearly 90 million patients, including about 1 in 3 Medicare Advantage enrollees. APG’s motto, ‘Taking Responsibility for America’s Health,’ represents our members’ commitment to clinically integrated, coordinated, value-based health care in which physician groups are accountable for the costs and quality of patient care. Visit us at www.apg.org.
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