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New York Times: Study Finds Mortality, Utilization Benefits CareMore ESRD Special Needs Plan

Amol Navathe, M.D., Ph.D., says you can think about Medicare Advantage plans as a form of accountable care. “Medicare Advantage plans are capitated, meaning get a fixed budget for each Medicare beneficiary who elects to enroll them. They are at risk for both quality and cost outcomes,” explained Navathe, an assistant professor of health policy and medicine at the University of Pennsylvania. “It is version of accountable care, if you will, that is different than the alternative, which is the traditional fee-for-service system, which is great, in some senses. It [traditional fee-for-service Medicare] provides great coverage. Almost every physician and hospital out there take Medicare. So it gives people a lot of choice. But oftentimes there is a lot less coordination of care and coordination of benefits (than in Medicare Advantage plan).” Navathe, along with six other colleagues, set out recently to compare a Special Needs Plans for Medicare beneficiaries with end-stage renal disease (ESRD) sponsored by CareMore, a subsidiary of Anthem, with traditional Medicare fee for service. They reported their results in the September issue of Health Affairs. The study was supported by grant from the Anthem Public Policy Institute. Read more on Managed Healthcare Executive.

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