Members of Congress, the Administration, and others such as the Medicare Payment Advisory Commission (MedPAC), have expressed specific concern that, in the Medicare fee-for-service program, hospital readmission rates are too high and that a lack of care coordination is causing unnecessary hospitalizations. The Alliance of Community Health Plans (ACHP) asked Dr. Gerard Anderson, Professor at Johns Hopkins University, to undertake a study examining hospital readmissions and preventable hospitalizations in order to compare the rates in fee-for service Medicare to the rates in the Medicare Advantage plans offered by ACHP member organizations. The study also estimates the possible cost savings if Medicare fee-for-service had the same rates of readmissions and preventable hospitalizations as ACHP member health plans. ACHP members are regional and community-based health plans across the country that emphasize coordination of care, integrated systems, and close plan/provider relationships.

The three measures used in the study – hospital readmissions within 30 days, preventable hospitalizations and preventable emergency department (ED) visits – reflect access to primary care, care coordination, and other active management of patients. 

• Reducing hospital readmissions – measured in this study as return visits for any reason within 30 days – requires coordination among the hospital, ambulatory care clinicians, other service providers, and the beneficiary following discharge.
• Preventable hospitalizations and preventable emergency department visits are hospitalizations or ED visits that could have been prevented if there had been appropriate care for these "ambulatory care-sensitive conditions" (ACSCs). (ACSCs include such conditions as pneumonia, coronary artery disease, asthma, and diabetes.) This often requires coordination involving a wide range of clinicians and the Medicare beneficiary.

Full report: http://www.achp.org/policy/health_care_reform/study_of_ma_plans_vs_ffs/index.1.html  

Johns Hopkins University Bloomberg School of Public Health, Alliance of Community Health Plans. (2009). The benefits of care coordination: a comparison of Medicare fee-for-service and Medicare Advantage. Anderson, Gerald.