I agree with Bruce. Anybody who thinks Congress is really interested in savings thru more efficient care needs to look again at this chart. And again. And again.
This AHIP study was of two for-profit network-model Medicare Advantage HMOs. Most of the providers also deliver care under the fee-for-service Medicare program. The differences demonstrated do not represent providers applying a different standard of care depending on whether the patient is Medicare Advantage or FFS.
What the differences represent are 1) the success of selective marketing to the healthy by the Medicare Advantage HMOs, and 2) patient self-selection wherein healthier patients tend to respond to the marketing of additional benefits whereas sicker patients just want to continue under their current FFS arrangements.
Paying Medicare Advantage plans more taxpayer funds to take care of less expensive patients is a terrible waste of our limited resources.
I am sure glad that the private health plans accomplished this feat.
Imagine if government reported such a feat. John Goodman quickly would don sackcloth, throw ashes upon his head and gnash his teeth, wailing about how government is rationing health care and killing America’s old. Betsy McCaughey would synchronise.
By the way: if the private health plans accomplish all that saving without reducing the quality of the healht care experience of the elderly –there are no data on quality in the chart, but surely John’s assurance that quality is not only not impaied but imporved is good enough for this blog — one must wonder why these plans have to hold up the hapless US taxpayer for an extra 14% of tax money, over and above what similar beneficiaries would cost taxpayers in traditional Medicare. Could not the private plans make ample profits just off the great savings in utilization they reportedly — self-reportedly, to be sure — but reportedly achieve.
It’s a pretty interesting, and in many ways confusing, study. First, they are limiting their comparison to MA programs that are HMOs to standard FFS Medicare. I’d like to see a comparison between a more traditions MA PPO to standard Medicare.
Some of the details don’t make any sense if they are making truly risk adjusted comparisons. They claim fewer initial hospital days, fewer readmissions, and fewer office visits. How can that be? Are all the FFS physicians that less competent? Or do the HMOs simply place higher barriers to access, causing patients who truly need care to leave the HMOs. Or do they simply filter out sicker patients by marketing or worse.
Finally, Uwe Reinhardt’s comment is correct. If they have found a formula that cuts costs below that of standard Medicare, there’s no way to justify their subsidy
Hi, I am a simple high school student interested in health care and I am confused about this study. Is it implying that patients with MA plans are refused service as opposed to those with Medicare plans? I didn’t know most of healthcare was this complex. But I cannot believe Reinhardt commented on this blog.
That’s an incredible chart. It shows what complete hypocrits are running the show in Congress.
I agree with Bruce. Anybody who thinks Congress is really interested in savings thru more efficient care needs to look again at this chart. And again. And again.
This AHIP study was of two for-profit network-model Medicare Advantage HMOs. Most of the providers also deliver care under the fee-for-service Medicare program. The differences demonstrated do not represent providers applying a different standard of care depending on whether the patient is Medicare Advantage or FFS.
What the differences represent are 1) the success of selective marketing to the healthy by the Medicare Advantage HMOs, and 2) patient self-selection wherein healthier patients tend to respond to the marketing of additional benefits whereas sicker patients just want to continue under their current FFS arrangements.
Paying Medicare Advantage plans more taxpayer funds to take care of less expensive patients is a terrible waste of our limited resources.
This is AHIP’s response to Don McCanne:
We risk adjusted, based on the CMS risk adjustment system.
We also gave FFS the benefit of the doubt by throwing out the dual eligible Medicare/Medicaid enrollees from FFS but not MA.
Risk scores were actually fairly similar between FFS and MA in a given region, especially after the duals were thrown out of FFS
I am sure glad that the private health plans accomplished this feat.
Imagine if government reported such a feat. John Goodman quickly would don sackcloth, throw ashes upon his head and gnash his teeth, wailing about how government is rationing health care and killing America’s old. Betsy McCaughey would synchronise.
By the way: if the private health plans accomplish all that saving without reducing the quality of the healht care experience of the elderly –there are no data on quality in the chart, but surely John’s assurance that quality is not only not impaied but imporved is good enough for this blog — one must wonder why these plans have to hold up the hapless US taxpayer for an extra 14% of tax money, over and above what similar beneficiaries would cost taxpayers in traditional Medicare. Could not the private plans make ample profits just off the great savings in utilization they reportedly — self-reportedly, to be sure — but reportedly achieve.
That remains a great mystery to me.
Happy holdiays to all.
Uwe
It’s a pretty interesting, and in many ways confusing, study. First, they are limiting their comparison to MA programs that are HMOs to standard FFS Medicare. I’d like to see a comparison between a more traditions MA PPO to standard Medicare.
Some of the details don’t make any sense if they are making truly risk adjusted comparisons. They claim fewer initial hospital days, fewer readmissions, and fewer office visits. How can that be? Are all the FFS physicians that less competent? Or do the HMOs simply place higher barriers to access, causing patients who truly need care to leave the HMOs. Or do they simply filter out sicker patients by marketing or worse.
Finally, Uwe Reinhardt’s comment is correct. If they have found a formula that cuts costs below that of standard Medicare, there’s no way to justify their subsidy
Hi, I am a simple high school student interested in health care and I am confused about this study. Is it implying that patients with MA plans are refused service as opposed to those with Medicare plans? I didn’t know most of healthcare was this complex. But I cannot believe Reinhardt commented on this blog.