New Avalere Study Finds that Mercy Care Plan Has 20 Percent Fewer Hospital Readmissions for its Dual Eligible Population than Medicare Fee-for-Service
Contact: Erica Garland, 202-745-5119,
Washington, D.C. – A new analysis by Avalere Health reveals that Arizona's Mercy Care Plan, a plan managed by Aetna, performs better than Medicare fee-for-service (FFS) for dual eligibles across four key measures: (1) access to preventive/ambulatory health services; (2) inpatient utilization (measured by hospitals days, discharges and length of stay); (3) emergency department utilization; and (4) all-cause readmissions. Dual eligibles are individuals who qualify for both Medicare and Medicaid, and represent a growing population often with significant health care needs.
Specifically, Avalere compared Mercy Care Plan dual eligible beneficiaries (approximately 16,800 individuals) and Medicare FFS dual eligible beneficiaries across the country on several standardized measures. When adjusted to match the health risk of the FFS dual eligibles, Avalere found that Mercy Care dual eligible members exhibited:
"Our analysis found that integrating Medicare and Medicaid for dual eligibles has the potential for savings by improving coordination across settings of care and reducing inpatient hospital utilization," said Bonnie Washington, senior vice president at Avalere. "These results suggest that policy makers should carefully consider some of the existing programs for dual eligibles as promising ways to improve health outcomes while reducing costs for dual eligible beneficiaries."
Since its1982 inception, Arizona's Medicaid program has required all participants to enroll in a Medicaid managed care plan. In addition to participating in Arizona's Medicaid managed care program, Mercy Care Plan also operates as a Medicare Advantage dual eligible special needs plan (DE-SNP) providing Medicare and Medicaid covered services including acute, long-term care and pharmacy services. Approximately 23 percent of the Mercy Care dual eligible population receives long-term care, and 5 percent are developmentally disabled.
"Aetna believes this study demonstrates the success of Mercy Care Plan in providing care for dual eligible members and that Aetna's experience with Mercy Care can serve as a national example of how to serve these members," said Kristi Matus, Aetna's executive vice president, Government Services. “Mercy Care Plan’s patient-centered model has successfully used intensive care management, as well as effective collaboration with providers and interdisciplinary teams to meet its dual eligible members' health care needs. Helping members stay healthy and at home is our first priority; it’s what members and their families want and is the best way to lower health care costs."
Mercy Care Plan is a not-for-profit health plan serving over 340,000 beneficiaries enrolled in Medicare, Medicaid, or both. Established in Phoenix, Arizona in 1985, Mercy Care is jointly sponsored in Phoenix by St. Joseph's Hospital and Medical Center (a member of Dignity Health) and, in Tucson, by Carondelet Health Network (a member of Ascension Health). Mercy Care uses interdisciplinary teams, including physicians, pharmacists, nurses and behavioral health specialists, to support intensive case management programs that are operated and managed by Aetna. Though benefits are financed from two different programs—Medicare and Medicaid—Mercy Care has organized an integrated approach to simplify navigating the two systems. The study noted that care coordination initiatives have the potential for savings by improving coordination across settings of care and reducing inpatient hospital utilization.
For each of the measures included in this analysis, results were computed in accordance with the 2012 Healthcare Effectiveness Data and Information Set (HEDIS) specifications. For the FFS population, Avalere used the CY 2008-2009 Medicare Standard Analytic Files (SAFs) including specific service dates (the services measured were provided in 2009; the 2008 data were used for risk adjustment). Mercy Care provided parallel results using their plan data. This analysis was subject to some limitations. For example, while Avalere captured both full and partial duals in the Medicare FFS dual eligible control group, the Mercy Care Plan only enrolls full duals. Although Avalere's results were risk-adjusted, because partial duals may have access to greater resources than full duals, the difference in populations may have had some impact on findings. Also, to identify the Medicare FFS dual eligibles in the 2009 Standard Analytic Files, Avalere was limited to using indicators known to either undercount or overcount duals depending on the state. The analysts used a linear regression method to risk adjust the measures of inpatient utilization, Emergency Department visits and adults' access to preventive/ambulatory health services. Alternative methods are frequently used to model these types of quality measures, particularly for patient-level risk adjustment. However, after exploring these other model structures, it was determined that these alternatives did not provide any considerable gains in overall risk adjustment predictive power.
Avalere Health is an advisory services company whose core purpose is to create innovative solutions to complex healthcare problems. Based in Washington DC, the firm delivers research, analysis, insight, and strategy for leaders in healthcare business and policy. Avalere's experts span 170 staff drawn from the federal government (e.g., CMS, OMB, CBO, and the Congress), Fortune 500 healthcare companies, top consultancies, and nonprofits. The firm offers deep substance in areas ranging from healthcare coverage and financing to the changing role of evidence in healthcare decision-making. Its focus on strategy is supported by a rigorous, in-house analytic research group that uses public and private data to generate quantitative insight. Through events, publications, and interactive programs, Avalere also translates real-time healthcare developments into actionable information.
Learn more at www.avalerehealth.net.
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