‘Two-sided risk’ Medicare Advantage plans improve patient outcomes

America’s health system is buckling under the weight of several converging pressures: an aging population, high rates of chronic disease, a shortage of clinicians, and rising costs. The response to these challenges will determine the future of care in this country — and new evidence suggests the solution is rooted in how we deliver and pay for care.

A peer-reviewed study published in the American Journal of Managed Care by America’s Physician Groups (APG), CareJourney, and Optum looked at whether health outcomes for dual-eligible Medicare and Medicaid patients (people who qualify for both Medicare and Medicaid) vary depending on the payment model they’re treated under.  

We examined health outcomes data under three different Medicare payment models: at-risk, or “two-sided risk” Medicare Advantage plans (where physician groups take full financial risk for patient care); fee-for-service (FFS) Medicare Advantage (where providers are paid per service by the Medicare Advantage plan insurer); and traditional Medicare (where providers are paid per service by the government).