Avoidable Hospitalizations Less Common in Medicare Advantage, Study Finds

Health Payer Intelligence November 14, 2023
Victoria Bailey

Medicare beneficiaries with ambulatory care-sensitive conditions visited clinicians with lower rates of avoidable hospitalizations.

Medicare Advantage beneficiaries were less likely to have avoidable hospitalizations than those in traditional Medicare, suggesting that the use of provider networks in Medicare Advantage may reduce unnecessary healthcare utilization, according to a study published in JAMA Health Forum.

A key difference between Medicare Advantage and traditional Medicare is the private program has provider networks that, on average, limit beneficiaries to visit around 40 percent of local physicians for in-network care.

Physicians play an essential role when it comes to avoiding hospitalizations for ambulatory care-sensitive conditions (ACSCs) like diabetes and hypertension.

Researchers used 2018 and 2019 Medicare Advantage encounter data and traditional Medicare claims data to...

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