This Health Plan Carries Lessons for COVID-19 Pandemic, Opioid Crisis

A global pandemic that has taken more than 400,000 lives in the United States alone and laid bare persisting racial disparities in health care.

The resulting uptick of loneliness, isolation, and mental health challenges.

Continued worry about the high cost of prescription drugs.

Questions of how to achieve access to quality care at affordable cost.

These are enormous challenges in health care, all against the backdrop of a newly inaugurated president.  

2020 put the entire U.S. health care system through unprecedented strain, bringing a series of watershed events that revealed strengths and weaknesses in our ability to deliver care where and when it is needed. 

The same U.S. health care system that developed and secured approval of an effective COVID-19 vaccine at breakneck speed and quickly brought the doctor’s office to patients’ living rooms – with insurance plans waiving cost-sharing for telehealth and seniors giving the technology a 91 percent favorability rating – also saw hospitals again overwhelmed and a surge in opioid overdoses as the nation still faces major uncertainties in the response to the coronavirus pandemic.

In these moments, our leaders are right to look for what works, identifying models of success that can be replicated elsewhere in our vast health care infrastructure. 

A new data analysis commissioned by the Better Medicare Alliance and conducted by Avalere Health, shows that Medicare Advantage – the public-private partnership in Medicare where more than 24 million beneficiaries receive coverage today – offers timely lessons in the face of our current health challenges.

Researchers at Avalere Health evaluated data on more than 1.4 million Medicare Advantage beneficiaries and 7.9 million Traditional Fee-for-Service Medicare beneficiaries, finding that Medicare Advantage outperforms Traditional Medicare on a host of indicators, including for high-need, high-cost beneficiaries. 

For example, data showed that beneficiaries in Medicare Advantage received a pneumonia vaccine 49 percent more often and a flu vaccine 11 percent more often than those in Traditional Medicare. As public health officials grapple with how to distribute the COVID-19 vaccine most effectively, combat skepticism, and target vulnerable populations, they should consider how Medicare Advantage’s unique ability to coordinate and manage care yields greater success in immunization rates.  

With COVID-19 impacting so many Americans’ mental health, and with the Medicare population disproportionately impacted by social isolation, findings also showed that Medicare Advantage beneficiaries had a 19 percent higher rate of receiving a screening for depression and an appropriate follow-up plan. For high-need, high-cost beneficiaries the contrasts are even more pronounced. Among beneficiaries under the age of 65 who enroll in Medicare due to a disability, depression screenings were 27 percent higher in Medicare Advantage over Traditional Medicare. 

What’s more, as the coronavirus pandemic exacts a painful toll on nursing homes nationwide, researchers found that Medicare Advantage beneficiaries used nearly 30 percent fewer days in skilled nursing facilities than their Traditional Medicare counterparts. 

Study findings also highlighted key prescribing behaviors that included a 16 percent lower use of high-risk medications like opioids. This deserves the attention of policymakers and the health care community as opioid deaths rise nationwide.  

For those who battle addiction, Medicare Advantage had a 29 percent higher rate of initiating treatment for alcohol or substance misuse. Among beneficiaries with major complex chronic conditions, Medicare Advantage has a 46 percent higher rate of initiating this addiction treatment.

All told, Medicare Advantage performed better than Traditional Medicare for all high-need, high-cost beneficiary populations on 72 percent of the 22 clinical quality of care measures studied – suggesting that Medicare Advantage can contribute to the answers ahead as we face today’s crises and build for the future. 

As a new Congress and administration search for common ground on health care and solutions to our deepest health challenges, support and protection for Medicare Advantage and the millions of Americans it serves may just provide the right path from which to begin. 


Allyson Y. Schwartz is president and CEO of the Better Medicare Alliance; she represented Pennsylvania in the U.S. House of Representatives from 2005 to 2015.

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