Quality Outcomes Under Medicare Advantage vs. Fee-for-Service

This white paper presents a comprehensive analysis of quality outcomes under Medicare Advantage (MA) compared to Medicare Fee-for-Service (FFS). The study aims to address the limited understanding of how these two coverage types impact the quality of care for Medicare beneficiaries, particularly among those with complex care needs and socioeconomic disadvantages. Utilizing Inovalon's extensive data assets, the research tracks individuals' healthcare outcomes from pre-65 commercial insurance to post-65 Medicare enrollment. The findings indicate that MA enrollees experience significantly better health outcomes, including over 70% fewer hospital readmissions and 25% fewer preventable inpatient admissions compared to FFS. The paper also discusses the implications of these findings for health plans and policymakers, emphasizing the importance of quality improvement initiatives, especially for socioeconomically disadvantaged populations. This work is timely in light of the Centers for Medicare & Medicaid Services (CMS) Health Equity Index framework, which will influence MA plan ratings and bonus payments.