May 9, 2025
Contact: Erin Hemlin, APG Vice President of Communications
ehemlin@apg.org; tel. 202-770-1901
WASHINGTON — The health care outcomes for Medicare Advantage (MA) enrollees whose physicians were taking full risk for the costs and quality of their care were far better than those of patients enrolled in traditional Medicare – even when all the patients were cared for by the same physicians, a new study[1] shows. Compared to the traditional Medicare patients, the outcomes for MA patients were superior across 16 of 20 measures, including these:
- The MA patients were 36 percent to 43 percent less likely than traditional Medicare patients to be hospitalized for acute and chronic conditions;
- They were 39 percent less likely to be readmitted to a hospital within 30 days of being discharged;
- They were 19 percent less likely to undergo avoidable hospital emergency department care; and
- They were 23 percent less likely to use high-risk medications that can be harmful or fatal if used incorrectly.
The results suggest that operating in full risk MA affords extra resources for physician groups to undertake preventive care, intensive case management, and other strategies that greatly improve overall care delivery for older adult populations, the study’s authors observed. The study and an accompanying infographic are available here.
The study, published today in the American Journal of Managed Care, examined the care provided by 17 large physician organizations with more than 15,000 physicians and contracted with 35 different MA health insurers. All the organizations are members of America’s Physician Groups, the leading entity representing physicians engaged in value-based payment models and accountable for the costs and quality of the health care that they provide. This study is the third in a series of studies published in peer-reviewed publications demonstrating the superior outcomes of care provided MA patients by physicians engaged in full risk relationships with MA plans. [2],[3] The study was jointly carried out by APG, Optum Translational Research, and CareJourney/Arcadia.
“When examining the differences between fully accountable Medicare Advantage and traditional Medicare, we found significant improvements in the MA model that exceeded both of our prior studies,” said lead author Ken Cohen, MD, Executive Director of Translational Research for Optum Health and a member of APG’s Board of Directors. “The findings from three rigorous analyses are unequivocal: Fully accountable care in MA provides better outcomes for both our patients and the health care system. “
“These results underscore our groups’ commitment to being held accountable for providing patient-centered, coordinated, integrated care that is fully accountable for costs and quality,” said Susan Dentzer, a study author and the president and chief executive officer of APG. “As we noted in our recently released report, Medicare Done Right: Prescriptions for Success, we will continue to make the case to policymakers that clinicians operating in full-risk relationships with MA plans receive far more resources than are available to them in traditional fee-for-service Medicare to provide the robust primary care that older adults increasingly require.”
About America’s Physician Groups
APG’s approximately 360 physician groups comprise 170,000 physicians, as well as thousands of other clinicians, providing care to nearly 90 million patients including about 1 in 3 Americans and 1 in 3 Medicare Advantage enrollees. APG’s motto, ‘Taking
Responsibility for America’s Health,’ represents our members’ commitment to clinically integrated, coordinated, value-based health care in which physician groups are accountable for the costs and quality of patient care. Visit us at www.apg.org.
[1] Cohen K, Vabson B, Podulka J, et al. Health outcomes under full-risk Medicare Advantage vs traditional Medicare. Am J Manag Care. Published online May 9, 2025. doi:10.37765/ajmc.2025.89740
[2] Cohen KR, Vabson B, Podulka J, et al, Medicare Risk Arrangement and Use and Outcomes Among Physician Groups. JAMA Netw Open. 2025; 8(1):e2456074. 10.1001/jamanetworkopen.2024.56074
[3] Vabson B, Cohen K, Ameli O, et al. Potential spillover effects on traditional Medicare when physicians bear Medicare Advantage risk. Am J Manag Care. Published online February 26, 2025. doi:10.37765/ajmc.2025.89686.
