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.
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.
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 cross-sectional study found those enrolled in Medicare Advantage (MA) had lower rates of low-value care than those enrolled in Traditional Medicare (TM). The most significant reduction was seen when comparing MA beneficiaries in two-sided risk models to their TM counterparts. But even within MA, beneficiaries in two-sided risk arrangements received fewer low-value services than those in MA fee-for-service plans.
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.
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.
