Op/Ed: Research underscores value of health care innovation under Medicare Advantage

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Health care gets ever more important as we get older. For over 50 years, Medicare has been there for America’s senior citizens, and fortunately, it’s getting better with age. The evidence is in on Medicare Advantage: competition within the program is driving quality, affordability, and innovation.

Medicare Advantage is the version of Medicare that allows beneficiaries to select a participating, private health plan. Most seniors will find over a dozen plans to choose from in their area, including several options with no premium. In contrast to “a la carte” Medicare, Medicare Advantage includes everything seniors may need, from major medical to prescription drug coverage and wellness programs.

Among the most exciting advancements has been Medicare Advantage’s focus on whole-patient care. Health plans are responding aggressively to the many studies underscoring the importance of social determinants of health, the factors beyond lab numbers and disease diagnoses that affect our well-being.

We now know that transportation access, socioeconomic status, and health care savvy can affect patient outcomes, so Medicare Advantage health plans are working hard to level the playing field. Initiatives run the gamut, from meal deliveries after hospital discharge and free rides for medical appointments to in-home clinical and support visits. Care coordinators assist with patient education and appointment scheduling, and they frequently help members tap community and government services to enhance nutrition, social engagement, home safety, and more.

These efforts are paying off big. An analysis by Avalere Health, for example, revealed that Medicare Advantage members with chronic conditions experienced 22 percent fewer in-patient stays and 33 percent fewer emergency room visits than traditional Medicare users. Other research has demonstrated similar advantages in hospital readmissions and acute-care survival rates.

Medicare Advantage is also taking health care into the future, applying technology to track prescription safety, evaluate provider quality, and offer patients new ways to connect with their doctors. Digital monitoring is providing more data to help physicians make the best care decisions. And smartphone apps, videoconferencing, and 24/7 helplines are bringing medical experts to the patient at their convenience.

Even as seniors are enjoying cutting-edge care, they’re saving money with Medicare Advantage. In fact, their prescription drug costs are $2,600 per year lower than their cohorts’, according to an Express Scripts report. And with annual out-of-pocket expense caps, seniors living on a fixed income can manage their finances without compromising their health.

The savings extend to the government as well. Spending growth within Medicare trails far behind private-payer plans, and Medicare Advantage is especially efficient, spending 25 percent less per beneficiary, according to the National Bureau of Economic Research. Such cost-effectiveness derives from the right mix of preventative care, value-based contracts, and astute management.

It seems the policy fights over health care never end. Before making any changes to health care, however, our elected leaders must take full stock of Medicare Advantage. Only when fully informed by the latest research into its success can policymakers enact solutions to keep the program moving in the right direction.

Bill Cashin

Former Manchester Alderman