Clinical Outcomes
First study of its kind shows better outcomes in value-based care versus fee-for-service Medicare
Author and Expert:
Dr. Cohen
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Evidence-based studies that demonstrate the impact of value-driven reimbursement and care delivery on patient outcomes will compel more physicians to move to a more sustainable health care delivery model, says Dr. Kenneth Cohen, a physician leader, practicing physician and researcher who has devoted his career to advancing evidence-based medicine and delivering value-based care.
A study directly comparing results from a Medicare Advantage (MA) two-sided risk model to fee-for-service (FFS) Medicare is making a positive impact in the transformation to value-based care.
According to Kenneth Cohen, MD, FACP, executive director of translational research for Optum Health and co-author of the study published in JAMA Network Open, the research speaks to the value of coordinated care, evidence-based practices and the alignment of financial incentives with patient outcomes.
“The implications of the study are far-reaching as they validate value-based care as the path forward to more affordable care that delivers better results,” said Dr. Cohen. “We’ve seen some studies that demonstrate better outcomes in value-based models, but this is the first comparison with FFS, which is critical because it shows how clear the rationale is for moving to a model rooted in delivering high-value appropriate care. This level of data analysis is extremely important in driving the adoption of value-based programs.”
Study results point to effective preventive care
The study “Comparison of Care Quality Metrics in 2-Sided Risk Medicare Advantage vs Fee-for-Service Medicare Programs” included data analyzed from more than 316,000 people, split evenly between the two programs.
The results indicate Optum’s unique approach to value-based care better served MA patients by delivering more efficient and higher-quality patient care. Key findings for diseases studied, such as chronic obstructive pulmonary disease, stroke and myocardial infarction, include:
- 44% reduction in odds for hospital admission for COPD
- 14% lower risk of avoidable Emergency Department (ED) visits
- 18% lower risk of inpatient admission
- 10% lower risk of stroke and myocardial infarction
- 9% lower rates of 30-day readmission
According to Dr. Cohen, providing primary care physicians with evidence-based tools so they could deliver the right care at the right time was a key success factor of the program.
For example, the program ensured 90% of patients had annual wellness visits where clinicians could prioritize immunizations, screenings and disease management – all of which support avoidable hospital admissions and ED visits.
Data-driven care decisions affect outcomes
With data and analytics to drive value-based decisions, physicians could also choose more effective drugs at lower costs, ultimately benefitting patients clinically and economically. Dr. Cohen explained one drug they evaluated was an expensive migraine medication. Physicians were able to compare costs and research for all medications that reduce the frequency of chronic migraines and find effective, lower-cost options for patients.
They also had access to quality performance data that gave them visibility into which specialists were delivering high-value care. With this information at their fingertips, they could be more targeted with their referrals and continue to direct patients to quality care.
In addition, the data helped to stratify the population and identify at-risk patients, so physicians could implement disease interventions and lower the risk of hospitalizations.
“The MA model of care provides revenue to risk stratify patients and deploy sophisticated care management strategies for the highest risk patients that otherwise wouldn’t be possible in FFS,” continued Dr. Cohen. “These strategies also drive a critical shift from patients paying for low-value care to instead paying the same price for high-value care and getting better results.”