UnitedHealth Group’s Response to the Wall Street Journal’s Recent Reporting on Medicare Advantage

The Facts: Medicare Advantage Delivers Better Outcomes, More Coverage and Lower Costs

In a series of misleading articles, the Wall Street Journal has waged a one-sided, biased attack on Medicare Advantage (MA) – a program millions of seniors rely on for health care. The narratives woven through the articles rely on often incomplete and inaccurate data to conduct flawed studies through a murky government “agreement”, and clearly demonstrate that the Journal does not understand the Medicare Advantage program, how it is designed to function or why it differs from the traditional fee-for-service program which emphasizes volume over quality and patient outcomes.  We have provided overwhelming evidence demonstrating the value of MA to seniors, the government and taxpayers, offering data and third-party analysis to encourage a more complete and accurate representation of the Medicare Advantage program – evidence the WSJ has chosen to ignore.  

Ironically, and despite their best effort to the contrary, the WSJ articles actually highlight many of the reasons why Medicare Advantage plans are so popular with seniors, while also lowering the burden on taxpayers.

For instance, the most recent article focuses on elements of the MA program that are designed to help proactively identify health risks, before seniors have major health problems. Not surprisingly, the WSJ found MA plans do a much better job of identifying and documenting health risks than traditional Fee-For-Service Medicare, which is driven by MA plans’ focus on proactive and coordinated care models that identify, document and treat chronic conditions early on, which leads to better health outcomes for those we serve. There is well established research that documents these differences between Medicare and Medicare Advantage, and which underpins the regulations used to pay MA plans for the cost of providing benefits to the populations they cover.

Additionally, MA members that are served by an Optum provider benefit from innovative clinical models and a value-based care approach that leads to more accurate diagnoses, greater availability of care and better health outcomes and prevention including less hospitalization, more cancer screenings and better chronic disease management.

CMS constructed Medicare Advantage to incent the early identification and treatment of conditions to help seniors avoid more serious health issues and get the care they need. The WSJ fails to understand or accept that MA plans are doing exactly what the program was designed to do – meet the government’s objective of delivering better health outcomes and lower costs for seniors.

 

The Facts: Better Outcomes at Lower Costs

 

Better Health Outcomes

Medicare Advantage delivers higher-quality care than Medicare fee-for-service.

• Medicare Advantage beneficiaries have a 43% lower rate of avoidable hospitalizations for any condition.   
• Medicare Advantage dual-eligible beneficiaries experience fewer hospitalizations and are more likely to receive preventive services like breast cancer screenings. 
  • 33% fewer total hospitalizations. 
  • 49% fewer potentially avoidable hospitalizations for acute conditions. 
  • A higher frequency of testing and preventive services, including a 46% higher rate of breast cancer screening. 
• In an accepted study that will be published in JAMA Network Open in January, a retrospective cross-sectional regression analysis of CMS enrollment and encounter data from 2016-2019, merged with a contemporaneous APG provider dataset, found at-risk Medicare Advantage had higher quality and better health resource utilization outcomes when compared to FFS Medicare Advantage. 

 

Medicare Advantage patients served by Optum in comprehensive, fully accountable care models saw healthier outcomes compared to those in Medicare fee-for-service. These include:

• 18% lower risk of an inpatient admission. 
• 11% lower risk of emergency department (ED) visits. 
• 44% reduction in hospital admissions for COPD or asthma complications. 
• 6% lower risk of inpatient acute admission from the ED. 
• 9% lower rate of 30-day hospital readmission. 
• 10% lower risk of admission for stroke or myocardial infarction.

 

We are consistently delivering differentiated clinical quality through evidence-based medicine, better chronic disease management, and deeply coordinated care.

• Nearly three-fourths of Medicare Advantage patients in our value-based care models were screened for breast cancer and colorectal cancer.
• More than 90% of our Medicare Advantage patients with hypertension adhere to medication recommendations.

• For patients with diabetes, uncontrolled hemoglobin A1c levels can lead to severe complications. But with a dedicated care team to help manage diet, lifestyle and medications, 70% of diabetic patients under our care have control of their A1c levels, an 11-point increase year over year.   

 

Lower Costs

Medicare Advantage is more affordable for patients and reduces costs for the broader health system. 

Patients: 

• 2006 marked the first time every Medicare beneficiary had access to at least one Medicare Advantage plan; at that point, just 6 million people were enrolled, 14% of eligible Medicare consumers. Today, nearly 35 million consumers choose Medicare Advantage — that’s more than 50% of all who are eligible.
• In 2024, 75% of MA enrollees, including those in UnitedHealthcare plans, paid no monthly premium. 
• Seniors in MA save 45% on premiums and out-of-pocket costs each year, which translates to an average savings of $2,800 annually compared to those in fee-for-service (FFS) Medicare. 

 

Health system: 

• In 2022, 11 Optum Accountable Care Organizations generated more than $162 million in savings in Medicare spending under the Medicare Shared Savings Program. 
• Medicare Advantage saves the health system 12% over FFS Medicare. 
• With the transition to a new risk adjustment model, relatively flat payments to MA plans are expected, while FFS spending is projected to continue growing on a year-over-year basis. 
• Per person payments to MA plans will be 3% less than they would have had they followed FFS Medicare spending trends and these savings could increase to 9% by 2026.