Format

Send to:

Choose Destination
See comment in PubMed Commons below
Health Aff (Millwood). 2013 Jul;32(7):1228-35. doi: 10.1377/hlthaff.2012.0773.

Medicare beneficiaries more likely to receive appropriate ambulatory services in HMOs than in traditional medicare.

Author information

  • 1Department of Health Care Policy, Harvard Medical School, Boston, MA, USA. ayanian@hcp.med.harvard.edu

Abstract

With quality-of-care bonus payments now available for Medicare Advantage health maintenance organizations (HMOs) and for accountable care organizations in traditional Medicare, the need to understand the relative quality of care delivered to Medicare enrollees has increased. We compared the quality of ambulatory care from 2003 through 2009 between beneficiaries enrolled in Medicare Advantage HMOs and those enrolled in traditional Medicare, and we assessed how the performance of various types of Medicare HMOs differed from that of traditional Medicare for these same measures. We found that beneficiaries in Medicare HMOs were consistently more likely than those in traditional Medicare to receive appropriate breast cancer screening, diabetes care, and cholesterol testing for cardiovascular disease. We also found that Medicare HMO physicians were rated less favorably by their patients than were physicians in traditional Medicare in 2003; however, by 2009 the opposite was true. Not-for-profit, larger, and older Medicare HMOs performed consistently more favorably on clinical measures and ratings of care than for-profit, smaller, and newer HMOs. Our results suggest that the positive effects of more-integrated delivery systems on the quality of ambulatory care in Medicare HMOs may outweigh the potential incentives to restrict care under capitated payments.

KEYWORDS:

Elderly; Managed Care—Medicare; Medicare; Quality Of Care

PMID:
23836738
[PubMed - indexed for MEDLINE]
PMCID:
PMC3925369
Free PMC Article
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for HighWire Icon for PubMed Central
    Loading ...
    Write to the Help Desk