Medicare Advantage: Can At-Risk Models Deliver Better Care?
April 15, 2025April 15, 2025
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Medicare Advantage: Can At-Risk Models Deliver Better Care?

A recent study published in JAMA Network Open suggests that physician groups operating under at-risk Medicare Advantage (MA) payment models (2-sided risk) may be delivering higher-quality, more efficient care than their fee-for-service (FFS) counterparts.

The study, led by Dr. Ken R. Cohen and a team of researchers, analyzed Medicare claims and enrollment data from 2016 to 2019 covering 17 physician groups, 15,488 physicians, 35 health insurers, and over 5.2 million patient-years. The goal? To determine whether shifting financial risk to providers leads to better outcomes for Medicare beneficiaries.

Key Takeaways

Findings indicated that at-risk MA models delivered superior results in 18 out of 20 quality and efficiency measures, outperforming traditional FFS MA, across four key areas: hospital care, emergency department (ED) use, prevention of disease-specific admissions, and outpatient care.  After adjusting for risk and patient mix, the authors’ results show:

  • Fewer Hospital Admissions – Patients in at-risk MA had 10 fewer hospital admissions and nearly 2 fewer readmissions per 1,000 people compared to FFS MA.
  • ED Use – Total ED visits dropped by 26 per 1,000 people, while avoidable ED visits were 3 per 1,000 lower under at-risk MA.
  • Better Chronic Disease Management – Hospitalizations for diabetes, heart failure, and other chronic conditions were significantly lower in at-risk MA.
  • Improved Medication Adherence – Patients were more likely to take prescribed statins and blood pressure medications, and they were 14 per 1,000 less likely to be prescribed high-risk drugs.

Why Does This Matter?

MA enrollment is growing rapidly, with more than half of all Medicare beneficiaries now choosing MA plans. This study adds to a growing body of evidence that value-based payment models — where providers share in both the financial rewards and risks of patient care — can lead to better health outcomes and smarter healthcare spending.

At-risk physician groups have strong incentives to invest in population health strategies, preventive care, and social support services that help keep patients healthier and out of

For more information, contact your Account Manager today.