Data on Cardiovascular Research Discussed by Researchers at University of Pennsylvania Perelman School of Medicine (Changes in Health Care Utilization and Low-Value Service Use After Risk-Based Contract Adoption in Medicare Advantage): Cardiovascular Research

2025 NOV 24 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- Researchers detail new data in Cardiovascular Research. According to news reporting originating from Philadelphia, Pennsylvania, by NewsRx correspondents, research stated, “Although risk-based payment contracts to health care organizations can reduce health care utilization, there is limited evidence on how these contracts influence the value of health care services delivered, whether effects depend on contract design features, and what these contracts achieve in Medicare Advantage, the segment of US health insurance with the most adoption of risk-based contracts. To assess whether voluntary transition to risk-based contracts (either upside-only, with financial bonuses possible, or 2-sided with both bonuses and penalties possible) was associated with changes in either broad domains of health care utilization or use of low-value services.”

Our news editors obtained a quote from the research from the University of Pennsylvania Perelman School of Medicine, “This retrospective cohort study analyzed claims from January 1, 2015, through December 31, 2021, for beneficiaries enrolled in health maintenance organization plans from Humana, a large, national Medicare Advantage insurer. A difference-in-differences analysis measured changes in outcomes for health care organizations that newly transitioned to upside-only or 2-sided risk contracts compared with organizations with stable fee-for-service (FFS) or upside-only risk contracts, respectively. Statistical analysis was conducted between April 4 and June 23, 2025. Nine utilization measures in 3 domains (inpatient encounters, outpatient visits, testing) and 26 measures of low-value service use in 6 domains (cancer screening, diagnostic and preventive testing, preoperative testing, imaging, cardiovascular testing and procedures, and other surgeries). The sample included 658 organizations transitioning from FFS to upside-only risk contracts (1 042 272 beneficiary-years), 114 organizations transitioning from upside-only to 2-sided risk contracts (706 303 beneficiary-years), and 3385 control organizations (2 491 985 beneficiary-years). In difference-in-differences analyses, transitioning to upside-only risk contracts was associated with differential reductions in 4 of 9 utilization outcomes (emergency department visits, primary care visits, advanced imaging, and cardiovascular stress testing); however, when analyses accounted for differential temporal trends in outcomes prior to contract transitions, differential reductions were only detected for emergency department visits (-8.4% of baseline use; 95% CI, -15.5% to -1.3%; P = .02) and cardiovascular stress testing (-12.1%; 95% CI -23.4% to -0.7% P = .04). Transitioning to 2-sided risk contracts was associated with differential reductions in specialty visits and advanced imaging; however, neither association was detected after accounting for pretransition outcome trends. Neither type of contract adoption was associated with differential changes in total use of low-value services or differential reductions in any domain of low-value service use. This study found that voluntary transition to upside-only or 2-sided risk payment contracts in Medicare Advantage was not associated with consistent changes in health care utilization or low-value service use.”

According to the news editors, the research concluded: “It is uncertain what factors account for the lack of apparent changes.”

This research has been peer-reviewed.

For more information on this research see: Changes in Health Care Utilization and Low-Value Service Use After Risk-Based Contract Adoption in Medicare Advantage. JAMA Internal Medicine, 2025. JAMA Internal Medicine can be contacted at: Amer Medical Assoc, 330 N Wabash Ave, Ste 39300, Chicago, IL 60611-5885, USA.

The news editors report that additional information may be obtained by contacting Soohyun Kim, Dept. of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. Additional authors for this research include Aaron L. Schwartz, Sumedha Chhatre, Amanda Sutherland, Aina Katsikas, Sara Riaz, Gosia Sylwestrzak, Emily Boudreau and Amol S. Navathe.

The direct object identifier (DOI) for that additional information is: https://doi.org/10.1001/jamainternmed.2025.5917. This DOI is a link to an online electronic document that is either free or for purchase, and can be your direct source for a journal article and its citation.

Publisher contact information for the journal JAMA Internal Medicine is: Amer Medical Assoc, 330 N Wabash Ave, Ste 39300, Chicago, IL 60611-5885, USA.

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