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Medicare Advantage

An Unexpected Way Seniors Can Steer Clear of the Hospital

Efrem Castillo, M.D., is the chief medical officer of UnitedHealthcare Medicare & Retirement

If you’re over 65 and notice that you’re trekking to doctor appointments more frequently than you used to or your medicine cabinet is growing increasingly crowded, you’re not alone.  

Most of us have accepted the reality that our bodies need more care and attention as we age, and so we dutifully do all the things we think we should to help maintain our health and independence for as long as possible: see our doctor regularly, take our medications as prescribed, try to eat a healthy diet and so on. The hope, of course, is that choosing a healthy lifestyle will let us do more of what we love and also avoid the fate so many of us dread: winding up in the hospital hampered with a serious health condition.

But according to new research, steering clear of the hospital could have a lot to do not just with your lifestyle choices but also your Medicare choices. Turns out, if you opted to sign up for a Medicare Advantage plan last fall during the Annual Enrollment Period, your odds of being hospitalized or needing care in the emergency room are significantly lower than if you chose Original Medicare.

Here’s how the study worked: Researchers with health care consulting firm Avalere Health set out to directly compare people enrolled in Medicare Advantage plans, which are offered by private health insurance companies, with those who enrolled in Original Medicare.

Because more than half of people enrolled in Medicare have four or more chronic conditions, they were especially interested in understanding how people with chronic conditions fare under each type of Medicare coverage. So they assembled a group of people with at least one of three of the most common chronic conditions in older adults: high blood pressure, high cholesterol and diabetes. About half the group were enrolled in Medicare Advantage plans. The other half chose Original Medicare.

The study found that people with chronic conditions enrolled in Medicare Advantage plans had 23 percent fewer inpatient hospitalizations and 33 percent fewer emergency room visits. Not only were they less likely to wind up in the hospital, but they were also more likely to get the preventive care services they needed. Compared to the people in Original Medicare, Medicare Advantage members had higher rates of preventive screenings and tests, including 5 percent higher rates of LDL cholesterol testing and 13 percent higher rates of breast cancer screenings.

The results were particularly promising for people with diabetes. As compared to the study participants with diabetes who chose Original Medicare, those enrolled in Medicare Advantage plans had a 52 percent lower rate of complications and a 73 percent lower rate of serious complications such as leg or foot amputation.

What makes the study findings even more impressive is that people who are at higher risk of being in poor health are more likely to choose a Medicare Advantage plan. The study showed that Medicare Advantage plans had higher proportions of minorities, people of low income and people with disabilities as compared to Original Medicare. People who chose Medicare Advantage also had a 57 percent higher rate of serious mental illness and a 16 percent higher rate of substance abuse disorders.

At this point you might be scratching your head, wondering how exactly Medicare Advantage has such an impact on health outcomes for people with chronic conditions. The Avalere Health researchers chalked the findings up, in part, to Medicare Advantage plans’ focus on preventive care, management of chronic conditions, and coordination of care for their plan members. Many Medicare Advantage plans offer extra benefits not available with Original Medicare that are designed to enhance people’s health and quality of life, such as disease management and wellness programs, gym memberships and in-home health care.

In short, Medicare Advantage plans tend to put more emphasis on ensuring their members are receiving appropriate care and support when they’re healthy and their conditions are under control, which in turn appears to lower the risk of needing more intensive care in the hospital down the line.

Intrigued? You’re in luck. Your opportunity to make a change to your Medicare coverage is right around the corner. Let this latest research serve as your motivation to check out all the options available in your area this fall during the Annual Enrollment Period, which begins on Oct. 15. The findings indicate that it would be well worth your time to consider whether a Medicare Advantage plan could be the right choice for your coverage, and your health, in 2019.

Efrem Castillo, M.D., is the chief medical officer of UnitedHealthcare Medicare & Retirement. Serving more than 12.3 million people enrolled in Medicare, UnitedHealthcare is the largest business dedicated to the health and well-being needs of seniors and other beneficiaries.

Texas Doctors Earn More Than $5.7 Million in Quality of Care Bonus Payments for Improving Health Outcomes for UnitedHealthcare Medicare Advantage Members

UnitedHealthcare Infographic
UnitedHealthcare Infographic

UnitedHealthcare recently recognized more than 100 care providers in Texas with the 2015 UnitedHealthcare PATH Excellence in Patient Service Awards for their commitment to improving health outcomes for people enrolled in its Medicare Advantage plans.

These care providers earned more than $5.7 million in quality of care bonus payments for achieving performance metrics in the UnitedHealthcare PATH Program and successfully addressing care opportunities when treating more than 30,000 of UnitedHealthcare’s Medicare Advantage members in Texas. They are among more than 1,900 care providers nationwide who received the award and earned more than $148 million in quality of care bonus payments.

UnitedHealthcare created the PATH program to help people enrolled in its Medicare Advantage plans be as healthy as possible by encouraging greater use of preventive health care services and proactive monitoring of chronic conditions.

The program annually rewards physicians who meet certain performance-based criteria, including achieving or exceeding targets established by the Centers for Medicare & Medicaid Services (CMS) for specific Healthcare Effectiveness Data and Information Set (HEDIS) measures. Health plans and CMS use HEDIS as a tool to measure performance on important dimensions of health care and service.

Examples of the quality measures used to evaluate care providers’ performance in the 2015 PATH program include:

  • the percentages of eligible UnitedHealthcare Medicare Advantage members who received a breast cancer screening or colorectal cancer screening;
  • the percentage of members with diabetes who received an eye exam; and,
  • the percentage of members who received advice from their doctor to maintain or enhance their level of physical activity.

By achieving the PATH program’s performance metrics, care providers also proactively addressed care opportunities for UnitedHealthcare’s Medicare Advantage members. A care opportunity exists when an individual hasn’t received a health care service or medication recommended based on his or her age or health status. In 2015, care providers nationwide participating in the PATH program addressed nearly 1.8 million care opportunities for UnitedHealthcare’s Medicare Advantage members.

Since UnitedHealthcare established the PATH program in 2013, participating care providers have earned more than $213 million in quality of care bonus payments. Nearly 1 million UnitedHealthcare Medicare Advantage members are currently being treated by doctors who participate in the PATH program.

“The care providers in Texas who earned a PATH Excellence in Patient Service Award deserve recognition for their commitment to improving our plan participants’ health and well-being,” said Efrem Castillo, M.D., chief medical officer of UnitedHealthcare Medicare & Retirement. “These awards are one of the ways we are supporting the transition to a value-based health care system that rewards physicians for the quality of care they deliver to the people we serve.”

The PATH program provides support and incentives for both care providers and Medicare Advantage members to enhance their engagement in their health care and willingness to take action on their doctors’ treatment plan. The program has four components:

  1. Patient support and communication
  2. Actionable patient data and reporting
  3. Financial compensation for doctors
  4. Support for physician practices to enhance care coordination

The PATH program is part of UnitedHealthcare’s commitment to help shift the nation’s health care system to one that rewards quality and value instead of the volume of procedures performed. To facilitate this shift, the company offers a variety of value-based payment arrangements, including incentive programs like PATH, performance-based contracting, bundled payments and fully integrated accountable care organization (ACO) relationships.

Care providers nationwide are showing strong interest in a shift to value-based care. UnitedHealthcare’s total payments to physicians and hospitals that are tied to value-based arrangements have tripled in the last three years to $48 billion. By the end of 2018, UnitedHealthcare expects that figure to reach $65 billion.

For more information about the PATH program and UnitedHealthcare’s full spectrum of value-based initiatives, visit

Serving one in five Medicare beneficiaries, including nearly 759,000 in Texas, UnitedHealthcare is the largest business dedicated to the health and well-being needs of seniors and other Medicare beneficiaries.