6.15 million Medicare enrollees had COPD in 2019 (11 percent). Traditionally, these beneficiaries have been enrolled in Medicare fee-for-service (FFS), but this is changing. Today, COPD and CHF sufferers increasingly are choosing Medicare Advantage.

Medicare Advantage (MA) plans can prepare for this coming wave by implementing home solutions that leverage predictive analytics, advanced-care nurse practitioners, telehealth, digital communications, and remote patient monitoring. Spiras Health has introduced a comprehensive home-centered solution that mitigates avoidable hospitalizations costs by managing symptoms more effectively at home.

The proportion of Medicare Advantage members with serious chronic illnesses is growing. From 2015 to 2019, the percentage of COPD patients choosing Medicare Advantage over traditional Medicare jumped from 32% to 40% ¹ – most likely because Medicare Advantage costs less.

A report from UnitedHealth Group found that MA costs less in both premiums and out-of-pocket costs than fee-for-service Medicare – 39% less with MA for a typical 72-year-old with an income under $27,000.²

Another study found the average out-of-pocket spend in 2018 with Medicare Advantage to be $3,354 compared to $4,994 for traditional Medicare.

What’s more, nearly twice as many low-income beneficiaries faced a medical cost burden in 2018 with FFS (49.4 percent) compared to MA enrollees in the same predicament (26 percent).³

As a result, patients with complex, chronic illnesses, complicated by social determinants of health and other barriers to care are more likely to choose Medicare Advantage. Congestive heart failure is already slightly more common among Medicare Advantage beneficiaries—7.1 percent prevalence in Medicare Advantage compared to 5.9 percent in traditional Medicare.⁴

These patients, who often present multiple comorbidities, prior hospital admissions, higher frailty, poor nutritional and low socioeconomic status, face a high risk of readmission. They are often readmitted for related problems other than COPD and CHF, including pneumonia and cardiac failure, highlighting the need for close management.

Spiras Health provides a home-centered, multi-modal approach to care management, resulting in reductions in the total cost of care and improved quality metrics and member/provider satisfaction. Helping Medicare Advantage members manage their symptoms reduces the need for hospital and ER visits and lowers costs for the health plan.

“Delivering specialty care in the home makes Spiras Health the perfect fit for the Medicare Advantage market,” said Sue Freeman, VP of Clinical Experience. “As CMS increasingly shifts medical services to the home setting, including personal services, it makes sense to manage care for complex chronic conditions at home as well.The continuity of care, close symptom management, specialty expertise, and the personal relationships our clinicians develop are essential to keeping people out of the ER and hospital.”

Spiras Health’s multi-modal approach to home-based specialty care delivers improved satisfaction, measurable outcomes, and financial savings to its Medicare Advantage partners. Savings are achieved through substantial and sustained reductions in hospital and emergency department utilization through a scalable delivery model.

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To learn how to offer Spiras Health to your members with complex needs, contact us using the form below

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1. avalere.com/insights/medicare-enrollees-with-copd-compared-to-the-general-population#
2. healthpayerintelligence.com/news/medicare-advantage-costs-40-less-than-fee-for-service-medicare
3. Medicare Advantage Cost Burden Is Lower Than in FFS Medicare (healthpayerintelligence.com)
4. healthpayerintelligence.com/news/medicare-advantage-cost-burden-is-lower-than-in-ffs-medicare