Medicare advantage chronic special needs plan boosted primary care, reduced hospital use among diabetes patients

Health Affairs

Volumn 31, Issue 1, 2012, Pages 110-119

  Cohen, Robb ^a   Lemieux, Jeff ^b   Schoenborn, Jeff ^a,b   Mulligan, Teresa ^b  

^a XLHealth Corporation   (United States)

^b America's Health Insurance Plans   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ADULT; ARTICLE; CHRONIC DISEASE; COMPARATIVE STUDY; DIABETIC PATIENT; FEMALE; HOSPITAL; HOSPITALIZATION; HUMAN; MEDICARE; PRIMARY MEDICAL CARE;

DIABETES MELLITUS; FEE-FOR-SERVICE PLANS; FEMALE; HOSPITALIZATION; HUMANS; MALE; MEDICARE PART C; ORGANIZATIONAL CASE STUDIES; OUTCOME ASSESSMENT (HEALTH CARE); PRIMARY HEALTH CARE; UNITED STATES;

EID: 84855648819     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: 10.1377/hlthaff.2011.0998     Document Type: Article

References (7)

1. Cassidy A. Medicare Advantage plans. Health Affairs Health Policy Briefs [serial on the Internet]. 2011 Jun 15 [cited 2011 Dec 13]. Available from: http://www.healthaffairs.org/ healthpolicybriefs/brief.php? brief_id=48
2. To access the Appendix, click on the Appendix link in the box to the right of the article online
3. Readmission rates are often calculated on a thirty-day basis. Although thirty-day readmissions are a highly intuitive concept in theory, they can be tricky to measure in practice, and many different methods have been used. For example, are four admissions within a thirty-day span counted as three thirty-day readmissions (three admissions within thirty days of the prior admission), one thirty-day readmission (an incidence where there was at least one readmission within thirty days of an initial admission), or six thirty-day readmissions (the total number of admissions following any other admission within a thirty-day span)? For large populations, a much simpler method-the same-quarter readmission rate-is an excellent proxy for the thirty-day rate. The same-quarter rate is literally the number of admissions within a calendar quarter (for example, January through March or April through June) less one (to account for the initial admission). The same-quarter rate is especially useful for counting readmissions from the Medicare feefor-service 5 percent sample public use (Limited Data Set) files, which do not provide exact dates of service or day-gap indicators between admissions. More information on the same-quarter readmission rate is in Appendix A; see Note 2.
4. Of course, these reductions in hospitalization and readmission rates also reduce the potential for hospital-acquired infections or injuries. As an illustration, as part of a separate project, we estimated that patients in the fee-for-service sample used for the comparisons in this report incurred 130 specific hospital-acquired conditions or so-called never events based on their claims records in 2009. These included twenty cases of falls and trauma, seventy-nine cases of Clostridium difficile infection, twelve cases of vascular catheter infection, six cases of deep vein thrombosis, six cases of ventilatorassociated pneumonias, and three cases of stage III or IV pressure ulcers.
5. Gornick ME, Eggers PW, Reilly TW, Mentnech RM, Fitterman LK, Kucken LE, et al. Effects of race and income on mortality and use of services among Medicare beneficiaries. N Engl J Med. 1996;335:791-9.
6. Elliott MN, Haviland AM, Orr N, Hambarsoomian K, Cleary PD. How do the experiences of Medicare beneficiary subgroups differ between managed care and original Medicare? Health Serv Res. 2011; 46(4):1039-58.
7. Joynt K, Orav EJ, Jha A. Thirty-day readmission rates for Medicare beneficiaries by race and site of care. JAMA. 2011;305(7):675-81