Analysis of Medicare Advantage Enrollee Utilization and Spending

This technical report analyzes the demographics, healthcare utilization, spending, and quality of care among Medicare Advantage (MA) enrollees with chronic conditions, specifically hypertension, hyperlipidemia, and diabetes, compared to those in Fee-for-Service (FFS) Medicare. The study updates previous analyses by Avalere Health, utilizing 2019 claims and demographic data to compare trends in care delivery and outcomes. Key findings indicate that MA beneficiaries exhibit a higher proportion of racial and ethnic minorities and those enrolled due to disability compared to FFS. The report details that MA enrollees have lower inpatient utilization and emergency room visits, yet higher rates of physician visits. Furthermore, it outlines that MA beneficiaries incur lower overall healthcare spending on a per member per month basis across various expenditure types. Quality measures show similar results between MA and FFS beneficiaries, with MA enrollees demonstrating better rates of comprehensive diabetes care. The report also examines dual-eligible beneficiaries, noting similar trends in utilization and spending across both programs.