For Immediate Release
September 1, 2009
Medicare could save $10 billion annually
Lower rates of avoidable hospitalizations seen as key to ensuring
quality and controlling costs
DANVILLE, PA –Medicare Advantage plans had a 27 percent lower rate of avoidable hospital readmissions and 85 percent fewer preventable admissions and emergency department (ED) visits in a new analysis comparing 13 Medicare Advantage plans including Geisinger Gold to traditional fee-for-service Medicare. If the Medicare fee-for-service program had similar rates, the Medicare program would save approximately $10 billion annually.
The analysis is authored by Johns Hopkins University researcher Gerard Anderson, PhD, and commissioned by the Alliance of Community Health Plans (ACHP), a Washington-based membership organization of 19 non-profit, community-based and regional health plans and provider organizations from across the country. The plans are similar to Geisinger Health Plan because they all focus on improving the health of the communities they serve through coordinated care delivery and close working relationships with providers in their networks.
Geisinger Health Plan Chief Medical Officer, Duane E. Davis, M.D. believes the study results can be attributed to the nature of managed care. “As a managed care organization, we focus on improving results and increasing value. We work with primary care physicians to coordinate in the member’s care. We encourage referrals to make sure members’ care is coordinated. When referrals are handled correctly, the result is better care.”
Geisinger Health Plan (GHP) has several initiatives in place to improve coordination. A pioneer in disease management, GHP has offered disease and case management services to members with chronic illnesses since 1992. In 2006, services evolved into a medical home model, Geisinger Health Plan Health NavigatorSM. Health Navigator is a partnership between primary care providers and GHP to improve members' health by coordinating all aspects of their health care.
The Health Plan also ensures patients have access to their physician. GHP rates and incents physicians on a number of quality and access measures including the number of open same day appointments and expanded office hours. In addition, the Health Plan also offers a nurse line available around the clock to answer health questions members may have.
The report documents that it is possible to improve quality and lower costs in the Medicare program if the delivery system is structured differently. Like Geisinger Health Plan, the regional, community-based health plans that are ACHP members keep more of their Medicare patients out of the hospital and avoid unnecessary costs because they invest in coordinated, patient-centered medical care that traditional fee-for-service Medicare — in its current state — cannot consistently provide.
“ACHP commissioned this report in response to issues raised by Congress, the Administration and the Medicare Payment Advisory Commission (MedPAC),” said Patricia Smith, President and CEO of ACHP. “There is a broadly shared concern that hospitalization rates are too high and that a lack of coordination is the cause. Our goal for this report is provide guideposts for Congress as they write health reform legislation, and to work in partnership to establish sensible market incentives that will lead to coordinated, integrated care as well as continuous patient engagement.”
Readmission Rates and Hospitalizations/ED visits for Ambulatory Care Sensitive Conditions (ACSCs)
ACHP Medicare Advantage Plans compared to Medicare FFS |
|
Readmission rate per 100 discharges any DRG, 30 days |
Inpatient discharges for ACSCs per 100 member months |
ED visits for ACSCs per 100 member months |
ACHP plans-average |
13.6 |
2.5 |
2.2 |
Medicare Fee-for-Service |
18.6 |
19.0 |
15.5 |
Difference |
27% |
87% |
86% |
Preventable or so-called “Ambulatory Care Sensitive Conditions”(ACSCs) are those which could have been prevented had the patient received good primary care and related services. These include conditions such as pneumonia, coronary artery disease, asthma, and diabetes. |
Geisinger Health Plan, begun in 1985, is headquartered in Danville, PA and is one of the nation's largest rural HMOs. GHP is currently the top-rated plan in Pennsylvania and #5 in the country, according to the U.S. News and World Report and the National Committee for Quality Assurance (NCQA).* The Plan serves more than 220,000 members in 42 counties. Coverage is available for businesses of all sizes, individuals and families, and Medicare beneficiaries. HMO, PPO, high deductible and self-funded plans are available. As part of the Geisinger Health System, GHP has been recognized nationally as a model for health care reform with documented success in innovative programs such as the patient-centered medical home. For more information, please visit www.thehealthplan.com.
*“America’s Best Health Plans 2008-09” is a trademark of U.S. News and World Report.
For more information, please contact
Amy Bowen, Public Relations Coordinator, (570) 271-8135
