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Advantage plans helping to reduce readmissions, AHIP says


By Jennifer Lubell
Posted: July 28, 2010 - 6:30 pm ET
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Medicare Advantage plans are reducing avoidable hospital readmissions at a faster clip than traditional Medicare, the insurance industry claims, emphasizing the value of Advantage plans at a time when major cuts are slated for the plans under the new reform law.

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Advantage plans, long maligned for getting paid more than traditional fee-for-service Medicare, is facing $135 billion in direct federal spending reductions over the next ten years, according to the Congressional Budget Office. While the projected cuts “are of major concern” to the insurance industry, the focus of the briefing was to show what tools the industry has been using to reduce readmissions, something that everyone’s talking about, said Karen Ignagni, president and CEO of America’s Health Insurance Plans, which hosted the briefing.

The plans have been reducing avoidable readmissions by “smoothing the patient transition from hospital to the home,” achieving some of the goals outlined in the reform law to reduce readmissions, Ignagni stated.

Jeff Lemieux, senior vice president for AHIP’s Center for Health Policy and Research, presented a number of studies that compared the readmission rates between Medicare Advantage and fee-for-service plans across local areas and multiple states.

In most instances, the results had a similar pattern: the Advantage plan data yielded lower inpatient days, lower inpatient admissions, and lower avoidable readmissions, he said.

In assessing same quarter readmission rates across regions in Texas, for example, AHIP found that the statewide readmission rate for Medicare Advantage was 16.7%, compared with 20.5% for fee-for-service, Lemieux said.

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