D907 Task 1 Research Synthesis Brief Example

Past the Halfway Mark: What the Research Says About Medicare Advantage's Growth, and What It Means for a Regional Health System's Board

Student Name

Leavitt School of Health, Western Governors University

D907: Health Services Research, Task 1

Course Instructor

Month Day, Year

Past the Halfway Mark: What the Research Says About Medicare Advantage's Growth, and What It Means for a Regional Health System's Board

The Trend and Why the Board Should Care

Cascade Valley Health is a composite system of four hospitals whose board has asked for a briefing on Medicare Advantage, the option under which private plans contract with Medicare to cover beneficiaries. The question is timely. In 2026, 55% of eligible Medicare beneficiaries, 35.2 million of 64.2 million people with both Parts A and B, were enrolled in Medicare Advantage plans, up from 19% in 2007 (Freed et al., 2026). In Cascade Valley's region, the share is higher still. For a system that earns roughly 40% of its patient revenue from Medicare, the shift changes who pays for care, how decisions about care are approved and how patients move through its hospitals.

This brief synthesizes research on four questions the board has raised: how Medicare Advantage enrollees use care compared with people in traditional Medicare, whether their outcomes differ, how the shift affects hospital operations, and where the evidence is weak. It closes with options.

How the Evidence Was Gathered

I searched PubMed, KFF's research library and federal audit reports for studies and reports published since 2020 that compare Medicare Advantage with traditional Medicare or examine its effects on providers. I gave most weight to systematic reviews, large national studies and government audits, and I excluded commentary and industry marketing. The sources below were chosen because they speak directly to the board's questions.

Use of Care and Quality

On use of care, the research points in one direction. A systematic review of 48 studies found that, in most or all comparisons, Medicare Advantage was associated with more preventive visits, fewer hospital admissions and emergency visits, shorter hospital and skilled nursing facility stays and lower spending, and that it outperformed traditional Medicare on most quality-of-care measures studied (Agarwal et al., 2021). The same review found no consistent advantage for Medicare Advantage in patient experience, readmissions, mortality or racial and ethnic disparities (Agarwal et al., 2021).

Post-acute care shows the largest difference. In a national study of more than 7 million hospitalized beneficiaries, Medicare Advantage enrollees had greater reductions in post-acute care use than comparable traditional Medicare beneficiaries, including 6.3 fewer skilled nursing facility days and 3.6 fewer home health days, without worse outcomes: they had a slightly lower probability of readmission and spent about two more days in the community in the first 100 days after discharge (Roy et al., 2025).

Effects on Hospital Operations

The picture looks different from inside the hospital. Using 89.3 million admissions from 2017 to 2023, researchers found that average length of stay for Medicare Advantage admissions rose from 6.0 to 7.1 days, while stays for traditional Medicare rose only from 5.8 to 6.3 days (McGarry et al., 2025). The gap was largest for patients discharged to skilled nursing facilities, and prolonged stays among Medicare Advantage patients accounted for an estimated 1.8 million additional hospital bed-days in 2022 alone; the authors suggested that insurance-related discharge barriers may be responsible (McGarry et al., 2025).

Prior authorization is one such barrier. Among the prior authorization denials that federal auditors sampled, 13% involved requests that met Medicare coverage rules and would probably have been covered had the patients been in traditional Medicare (Office of Inspector General, 2022). For a hospital, each delayed approval for a skilled nursing facility transfer can mean an occupied bed that cannot be given to the next patient waiting in the emergency department.

Cascade Valley's own experience matches the national pattern. The system's case management department reviewed discharges to skilled nursing facilities over the last six months and found that patients with Medicare Advantage waited a median of 1.4 days longer than patients with traditional Medicare between the day they were medically ready to leave and the day they left, almost all of it spent waiting for plan approval. At the system's current occupancy, those days equal roughly one medical unit's worth of beds on a typical weekday.

Where the Evidence Conflicts and What Remains Unknown

The post-acute findings and the length-of-stay findings can both be true. Medicare Advantage plans appear to reduce use of skilled nursing facilities without harming outcomes on average, but part of the reduction may come from approval processes that keep some patients in hospital beds longer while they wait. Neither study measured the hospital's cost of those extra days, and neither can say which specific patients were helped or harmed.

The broader comparison also has limits. The systematic review cautioned that existing studies may not fully account for selection bias, differences in social determinants of health and risk adjustment, partly because Medicare Advantage and traditional Medicare data differ in quality (Agarwal et al., 2021). In practical terms, some of Medicare Advantage's apparent advantage may reflect who enrolls rather than what the plans do. Research is also thin on how Medicare Advantage growth affects rural hospitals and on how plan behavior differs by insurer.

Implications and Options for the Board

Three implications follow. Revenue from Medicare patients will increasingly depend on negotiated contracts and approval processes rather than on fixed Medicare rates. Hospital capacity is at risk when discharges wait on plan approvals. And the evidence that coordinated post-acute care can maintain outcomes with fewer facility days is an opportunity as well as a pressure.

Option one: strengthen contracting. Negotiate prior authorization turnaround times, clear rules for post-acute approvals and dispute processes into every Medicare Advantage contract, and track length of stay and denials by plan so negotiators have data. Option two: build post-acute partnerships. Develop a preferred network of skilled nursing facilities and home health agencies and work with plans on faster or delegated approvals for patients leaving the hospital. Option three: study risk-based arrangements. Consider value-based contracts with Medicare Advantage plans, which would let the system share in savings from coordinated care, but only after the data from options one and two show where the system can manage risk.

I recommend that the board direct management to pursue options one and two now and to report within a year on whether option three is feasible.

References

Agarwal, R., Connolly, J., Gupta, S., & Navathe, A. S. (2021). Comparing Medicare Advantage and traditional Medicare: A systematic review. Health Affairs, 40(6), 937-944. https://doi.org/10.1377/hlthaff.2020.02149

Freed, M., Biniek, J. F., Damico, A., Ochieng, N., & Neuman, T. (2026). Medicare Advantage in 2026: Enrollment update and key trends. KFF. https://www.kff.org/medicare/medicare-advantage-in-2026-enrollment-update-and-key-trends/

McGarry, B. E., Wilcock, A. D., Gandhi, A. D., Grabowski, D. C., & Barnett, M. L. (2025). Extended hospital stays in Medicare Advantage and traditional Medicare. JAMA Internal Medicine, 185(11), 1362. https://doi.org/10.1001/jamainternmed.2025.4411

Office of Inspector General. (2022). Some Medicare Advantage organization denials of prior authorization requests raise concerns about beneficiary access to medically necessary care (OEI-09-18-00260). U.S. Department of Health and Human Services.

Roy, I., Hutchins, F., Rose, L., Zhong, S., Patel, S. R., Kumar, A., Werner, R. M., & Burke, R. E. (2025). Postacute care use and outcomes among Medicare Advantage vs traditional Medicare beneficiaries. JAMA Network Open, 8(10), e2540347. https://doi.org/10.1001/jamanetworkopen.2025.40347