A Comparison of Home Health Utilization, Outcomes, and Cost Between Medicare Advantage and Traditional Medicare

Casebeer, Adrianne Waldman; Ronning, David; Schwartz, Richard; Long, Charron; Bhattacharya, Rituparna; Uribe, Claudia; Brown, Courtney; Cameron, Joy; Painter, Phil; Sharma, Anup; Spitale, Sandy; Powers, Brian; Stemple, Chuck; Shrank, William H.

doi:10.1097/mlr.0000000000001661

Cited by 6 publications

(20 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition, the study contributes to a relatively small but growing literature on use and value of home‐based care, in general, 25 and in MA, specifically. Overall, such studies of home‐based care in MA demonstrate lower rates of skilled home health care and post‐acute facility‐based care with similar or better outcomes 26,27,28,29 …”

Section: Discussionmentioning

confidence: 99%

“…Overall, such studies of home-based care in MA demonstrate lower rates of skilled home health care and post-acute facility-based care with similar or better outcomes. 26,27,28,29 This study has several strengths. The focus on use of HBMC in an understudied MA population is unique and important to understand as MA penetration in Medicare increases In addition, the sample size was large and leverages a dataset that is similar to the US MA population, enhancing its generalizability.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Prevalence of use and characteristics of users of home‐based medical care in Medicare Advantage

Leff

Ritchie

Ciemins

et al. 2022

J American Geriatrics Society

View full text Add to dashboard Cite

Background/Objectives Home‐based medical care (HBMC) is longitudinal medical care provided by physicians, advanced practice providers, and, often, inter‐professional care teams to patients in their homes. Our objective is to determine the prevalence of HBMC among older adults (≥65) insured by a Medicare Advantage (MA) plan and compare characteristics of those who receive HBMC to those who do not. Methods Study used de‐identified medical claims and enrollment records for MA beneficiaries during calendar years 2017 and 2018 linked with socioeconomic status data in the OptumLabs Data Warehouse. We defined a cohort of MA beneficiaries age ≥65 receiving HBMC for at least 2 months during 2017–2018, described the cohort using demographic, utilization, and comorbidity data and compared it to a 5% random sample of a population of MA beneficiaries age ≥65 not receiving HBMC (No HBMC). Results Overall, 1.45% of the study cohort age ≥65 received HBMC. Compared to No HBMC (n = 132,147), those receiving HBMC (n = 38,800) were more likely to be: older (46.6% vs. 11.9% age 85+); female (70.8% vs. 58.5%); Black (12.3% vs. 11.3%); urban (90.3% vs. 81.3%); experience hospitalization (38.0% vs. 13.3%), emergency department visit (58.3% vs. 26.9%), ambulance trip (44.1% vs. 9.6%), skilled nursing facility (37.6% vs. 6.4%), or hospice care admission (21.1% vs. 3.5%). They also were more likely to experience a wide range of chronic conditions including dementia (58.1% vs. 5.2%), morbidity burden (Charlson score 3.4 vs. 1.8), and serious illness (77.1% vs. 29.5%). All comparisons p < 0.0001. Conclusions MA beneficiaries who received HBMC are older, experience greater chronic and serious illness burden, and higher levels of facility‐based care than those who did not receive HBMC. MA plans need strategies to identify patients that would benefit from HBMC and develop approaches to deliver such care to this impactful, often invisible population.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Prevalence of use and characteristics of users of home‐based medical care in Medicare Advantage

Leff

Ritchie

Ciemins

et al. 2022

J American Geriatrics Society

View full text Add to dashboard Cite

show abstract

“…The studies were conducted in various settings. Sixteen (53%) were conducted nationally, [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] 5 (17%) were conducted across states, [27][28][29][30][31] 4 (13%) were conducted in a single state, [32][33][34][35] and the remaining 5 (17%) were single-site studies. [36][37][38][39][40] The sample sizes ranged from 100 patients to 42,978,689 patients.…”

Section: Characteristics Of Reviewed Studiesmentioning

confidence: 99%

“…In 19 (63%) studies, national administrative or claims data (eg, OASIS, MedPAR, MBSF) was used. [11][12][13][15][16][17][18][19][20][21][22][23][24][25][27][28][29]32,37 The Outcome and Assessment Information Set (OASIS), a standardized HHC data collection tool, was used most commonly in 15 (50%) studies. Three (13%) studies leveraged data from national surveys, including the National Medical Expenditure Survey (NMES), 13 the Health and Retirement Survey (HRS), 14 and the National Long Term Care Survey (NLTCS).…”

Section: Characteristics Of Reviewed Studiesmentioning

confidence: 99%

“…In 15 (50%) studies, authors clearly stated their study design, including observational longitudinal, 40 retrospective cohort, 11,12,16,[18][19][20]39 cross-sectional/correlational, 15,22,32,35 and quality evaluation/improvement designs. 27,28,36 The remaining 15 articles claimed secondary analyses 14,17,[23][24][25][26]28,32 or did not explicitly state the research designs.…”

Section: Characteristics Of Reviewed Studiesmentioning

confidence: 99%

See 1 more Smart Citation

Medicare Advantage and Home Health Care

Ma,

Rajewski,

Smith

2024

Medical Care

View full text Add to dashboard Cite

Objectives: Home health care serves millions of Americans who are “Aging in Place,” including the rapidly growing population of Medicare Advantage (MA) enrollees. This study systematically reviewed extant evidence illustrating home health care (HHC) services to MA enrollees. Methods: A comprehensive literature search was conducted in 6 electronic databases to identify eligible studies, which resulted in 386 articles. Following 2 rounds of screening, 30 eligible articles were identified. Each study was also assessed independently for study quality using a validated quality assessment checklist. Results: Of the 30 studies, nearly half (n=13) were recently published between January 1, 2017 - January 6, 2022. Among various issues related to HHC to MA enrollees examined, which were often compared with Traditional Medicare (TM) enrollees, the 2 most studied issues were HHC use rate (including access) and care dosage/intensity. Inconsistencies were common in findings across reviewed studies, with slight variations in the level of inconsistency by studied outcomes. Several critical issues, such as heterogeneity of MA plans, influence of MA-specific features, and program response to policy and quality improvement initiatives, were only examined by 1 or 2 studies. The depth and scope of scientific investigation were also limited by the scale and details available in MA data in addition to other methodological limits. Conclusions: Wild variations and conflicting findings on HHC to MA beneficiaries exist across studies. More research with rigorous designs and robust MA encounter data is warranted to determine home health care for MA enrollees and the relevant outcomes.

show abstract

Differences in Home Health Services and Outcomes Between Traditional Medicare and Medicare Advantage

Prusynski,

D’Alonzo,

Johnson

et al. 2024

JAMA Health Forum

View full text Add to dashboard Cite

ImportancePrivate Medicare Advantage (MA) plans recently surpassed traditional Medicare (TM) in enrollment. However, MA plans are facing scrutiny for burdensome prior authorization and potential rationing of care, including home health. MA beneficiaries are less likely to receive home health, but recent evidence on differences in service intensity and outcomes among home health patients is lacking.ObjectiveTo examine differences in home health service intensity and patient outcomes between MA and TM.Design, Setting, and ParticipantsThis cross-sectional study was conducted from January 2019 to December 2022 in 102 home health locations in 19 states and included 178 195 TM and 107 102 MA patients 65 years or older with 2 or fewer 60-day home health episodes. It included a secondary analysis of standardized assessment and visit data. Inverse probability of treatment weighting regression compared service intensity and patient outcomes between MA and TM episodes, accounting for differences in demographic characteristics, medical complexity, functional and cognitive impairments, social environment, caregiver support, and local community factors. Models included office location, year, and reimbursement policy fixed effects. Data were analyzed between September 2023 and July 2024ExposureTM vs MA plan.Main Outcomes and MeasuresHome health length of stay and number of visits from nursing, physical, occupational, and speech therapy, social work, and home health aides. Patient outcomes included improvement in self-care and mobility function, discharge to the community, and transfer to an inpatient facility during home health.ResultsOf 285 297 total patients, 180 283 (63.2%) were female; 586 (0.2%) were American Indian/Alaska Native, 8957 (3.1%) Asian, 28 694 (10.1%) Black, 7406 (2.6%) Hispanic, 1959 (0.7%) Native Hawaiian/Pacific Islander, 237 017 (83.1%) non-Hispanic White, and 678 (0.2%) multiracial individuals. MA patients had shorter home health length of stay by 1.62 days (95% CI, −1.82 to 1.42) and received fewer visits from all disciplines except social work. There were no differences in inpatient transfers. MA patients had 3% and 4% lower adjusted odds of improving in mobility and self-care, respectively (mobility odds ratio [OR], 0.97; 95% CI, 0.94-0.99; self-care OR, 0.96; 95% CI, 0.92-0.99). MA patients were 5% more likely to discharge to the community compared with TM (OR, 1.05; 95% CI, 1.01-1.08).Conclusions and RelevanceThe results of this cross-sectional study suggest that MA patients receive shorter and less intensive home health care vs TM patients with similar needs. Differences may be due to the administrative burden and cost-limiting incentives of MA plans. MA patients experienced slightly worse functional outcomes but were more likely to discharge to the community, which may have negative implications for MA patients, including reduced functional independence or increased caregiver burden.

show abstract

A Comparison of Home Health Utilization, Outcomes, and Cost Between Medicare Advantage and Traditional Medicare

Cited by 6 publications

References 28 publications

Prevalence of use and characteristics of users of home‐based medical care in Medicare Advantage

Prevalence of use and characteristics of users of home‐based medical care in Medicare Advantage

Medicare Advantage and Home Health Care

Differences in Home Health Services and Outcomes Between Traditional Medicare and Medicare Advantage

Contact Info

Product

Resources

About