The Health Care Transformation Hub elevates peer-reviewed and top-tier, reliable research from some of the leading researchers across the health care industry. Explore their findings and insights below.
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Medicare Advantage, Health Outcomes, Fee For Service, Care Quality, Traditional Medicare, Healthcare Costs,American Journal of Managed Care,2025
This retrospective study compared health outcomes for beneficiaries dually eligible for Medicare and Medicaid treated under three payment models: at-risk Medicare Advantage (MA), fee-for-service MA and traditional Medicare. Those in at-risk Medicare Advantage experienced better outcomes in 17 of 20 measures compared with traditional Medicare. Overall, those in at-risk MA arrangements experienced higher quality and lower utilization compared to those in traditional Medicare and fee-for-service MA.
D. Drzayich Antol, R. Schwartz, et al.
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October 01, 2025
Beneficiaries enrolled in Medicare Advantage (MA) had lower rates of hospital stays, emergency department visits and 30-day readmissions compared to beneficiaries in Traditional Medicare, suggesting MA managed care activities may influence the nature and quality of care.
E. Beltz, K. Thomas Craig, et. al
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September 01, 2025
This study compared clinical quality performance between value-based payment (VBP) and fee-for-service (FFS) models for Medicare Advantage members using 2022 Medicare Star Ratings data. VBP arrangements outperformed FFS across all 15 quality measures, with the largest improvements seen in blood glucose control (+25.5%) and blood pressure management (+23.3%). Performance increased progressively with greater financial risk-sharing. Overall, these findings suggest that VBP models, particularly those with higher risk-sharing, are associated with superior quality outcomes for prevalent and costly conditions like hypertension, diabetes, and cancer.
S. Sakowitz, S. Bakhtiyar, et. al
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September 01, 2025
This cross-sectional study looked at institutional markup ratios across US hospitals performing four major elective operations, finding that considerable variation exists across hospitals and those identified as having high-markup rates demonstrated having lower quality and value of care.
E. Politzer, T. Anderson, et. al
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August 01, 2025
This study compares the perioperative costs of elective surgical procedures for patients enrolled in Medicare Advantage (MA) versus traditional Medicare (TM). The study results suggest MA plans achieve cost savings through mechanisms like performing more procedures in outpatient settings and steering patients to more cost-effective facilities and procedures.
Peer-reviewed study showing Medicare Advantage enrollees whose physicians were under fully accountable models — taking full risk for the costs and quality of their care — have superior outcomes in 16 of 20 measures, including up to 43% fewer hospitalizations for patients with acute chronic conditions and 19% fewer avoidable ED visits.
This retrospective analysis of Medicare beneficiaries found that among patients with a new cancer diagnosis, those in Medicare Advantage plans experienced lower rates of low-value cancer treatments than those in Traditional Medicare.
The formation of accountable care organizations (ACOs), where groups of clinicians and health care organizations assume responsibility for the quality and costs of attributed patients, led to meaningful reductions in health care spending. Average annual per-patient spending was $142 lower in the first three years and $294 lower over 6 years compared to non-ACO patients, leading to $4.1 billion to $8.1 billion in savings to Medicare between 2012 and 2019.
This study is the first to demonstrate the advantages of value-based care can extend — or “spill over” — beyond Medicare Advantage patients to other Medicare recipients. These benefits include fewer hospitalizations for chronic illnesses, fewer emergency visits, more wellness visits and better medication adherence.
This study compared Medicare Advantage (MA) enrollees who received care in two-sided value-based care arrangements with those who received care in fee-for-service MA. The findings demonstrate MA full-risk value-based care arrangements are associated with higher-quality clinical care and better health results than the traditional MA model.
Among value-based purchasing contracts, higher-intensity programs — defined as upside-only or two-sided risk models — performed better on quality-process measures, quality-utilization measures and spending-reduction measures compared to lower-intensity programs such as prospective payments, bundled payments and pay-for-performance models.
This analysis compared Medicare Advantage (MA) HMO and PPO data and traditional Medicare data across a range of established quality and utilization measures. The authors found MA plans delivered superior clinical quality, improved patient-reported outcomes and lower utilization of health services compared to traditional Medicare.
This study compared Optum patients in fully accountable Medicare Advantage plans with a national random sample of administrative claims data for patients served by traditional Medicare fee-for-service. In every metric examined, the health of patients in Optum’s care model showed statistically significant improvements.
E. Boudreau, R. Schwartz, et. al
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September 01, 2022
This study analyzed beneficiaries enrolled in Medicare Advantage and Traditional Medicare to compare rates of low-value services between the two groups. Medicare Advantage enrollees received 9.2% fewer low-value services. Furthermore, Medicare Advantage enrollees whose primary care physicians were reimbursed under value-based arrangements received the fewest low-value services compared to those enrolled in Traditional Medicare. The researchers conclude that elements of insurance design present in Medicare Advantage are associated with reductions in low-value services.
This study investigates the spending and utilization differences between Medicare Advantage (MA) and Medicare Shared Savings Program (MSSP) beneficiaries. The study’s findings showed that per-member per-year spending for MSSP beneficiaries was consistently higher than for MA beneficiaries, even when controlling for clinical risk, suggesting health system participation in MA may be more favorable than MSSP.
Higher-risk payment models, such as global payment and shared savings, showed greater improvements in diabetes quality metrics and process measures compared to lower-risk pay-for-performance models such as fee-for-service Medicare.
This study reviewed the association between value-based payment models and acute care use among Medicare Advantage beneficiaries. While there was no significant difference in acute care use between upside-only risk models and fee-for-service models, MA beneficiaries cared for under 2-sided risk models had lower rates of hospitalizations, observation stays and ED visits.
A. Schwartz, K. Zlaoui, et. al
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December 01, 2021
This retrospective study compared health care utilization and spending between beneficiaries enrolled in Medicare Advantage plans and those enrolled in Traditional Medicare plans with a Medicare Supplement plan. The study looked at each group 1 year before vs. 1 year after their initial enrollment in Medicare. Findings showed that Medicare Advantage enrollees had fewer inpatient stays and a reduction in total spending equal to just 36% of the total spending in the Traditional Medicare cohort.
A literature review comparing Medicare Advantage (MA) to traditional Medicare. MA plans outperformed traditional Medicare in almost all areas of analysis, including higher rates of preventive visits, fewer ED visits and higher breast cancer screening rates.
This study analyzed trends in low-value care use and spending among individuals 65 years or older enrolled in the Medicare fee-for-service program from 2014 to 2018. Researchers found marginal decreases in low-value care use and spending during the study period, despite a coordinated, national campaign aimed at reducing low-value care. Opioid prescriptions for back pain actually increased during the study period, even in the midst of an ongoing opioid overdose crisis.
T. Badgery-Parker, S. Pearson, et. al
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April 01, 2019
This study of public hospitals in Australia measured hospital acquired complications associated with patients receiving seven procedures identified as being low-value. Analyses found that the use of these low-value procedures in patients who should not be receiving them harmed some of the patients, consumed additional hospital resources and potentially delayed care for other patients for whom those services would be appropriate.
A. Mandal, G. Tagomori, et. al
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February 01, 2017
This study compared two provider groups caring for statistically similar patient populations. One provider group was reimbursed through a fee-for-service model while the other group was reimbursed through a full-risk capitation model. Patients who received care from providers in the full-risk payment model had higher rates of office-based visits, fewer emergency department visits and fewer hospital admissions, saving ~$2 million per 1,000 enrollees. It also showed that intensifying office-based care for those with multiple comorbidities led to a 6% survival benefit and a ~33% lower hazard of death.
