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Home / News & IndustryManaged Care Insight and Analysis
Updated: March 30, 2010
It Can Be Done: CDPHP Found To Prove Quality Goes Up As Costs Go Down

Medicare Advantage plans score better than traditional Medicare fee-for-service plans in key quality criteria, according to a study by Johns Hopkins University. The study was commissioned by the Alliance of Community Health Plans (ACHP).

The report supports the assertion that it is possible to improve quality and lower costs in the Medicare program if the delivery system is structured differently.

ACHP is a Washington D.C.-based membership organization of 19 nonprofit, community-based, regional health plans and provider organizations from across the country.

It commissioned the Johns Hopkins study in response to "a broadly shared concern that hospitalization rates are too high and that a lack of coordination is the cause," said Patricia Smith, president and CEO of ACHP.

Based on 2007 data Capital District Physicians’ Health Plan (CDPHP) said its Medicare Choices plan reported significantly lower rates of avoidable hospital readmissions, preventable admissions, and emergency department visits than traditional Medicare. Based on that same data, CDPHP Medicare Choices’ hospital readmission rate (13.9 percent) was nearly five percentage points lower than traditional Medicare’s national average (18.6 percent). Hospital readmissions cost Medicare $17.4 billion in 2004.

CDPHP said it is able to put the brakes on readmissions because it invests in delivering the kind of integrated, coordinated, patient-centered medical care that traditional fee-for-service Medicare – in its current state – cannot consistently provide.

In addition to a comprehensive care coordination and case management program, CDPHP believes in the patient-centered medical home (PCMH) model of care and is in the midst of a 30-month PCMH initiative with three of its largest Capital Region practices.

"CDPHP Medicare Choices’ high degree of coordination and integration of care can serve as a blueprint for achieving better delivery, improved outcomes, and lower costs in the Medicare program," said John D. Bennett, president and CEO of CDPHP. "Our members who face the daily challenges of living with a chronic condition would prefer to receive good preventive care that keeps them healthy and out of the hospital."

CDPHP is a physician-founded and guided health plan. It and its affiliates currently serve members in 29 counties throughout New York state and seven counties in Vermont.

Addresses: Capital District Physicians’ Health Plan, 500 Patroon Creek Blvd., Albany, NY 12206; (518) 641-3000, www.cdphp.com. Alliance of Community Health Plans, 1729 H Street NW, Suite 400, Washington DC 20006; (202) 785-2247, www.achp.org.


  This article was taken from:
The Executive Report on Managed Care

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