Medicare Advantage and Traditional Medicare Hospitalization Intensity and Readmissions

Henke, Rachel Mosher; Karaca, Zeynal; Gibson, Teresa B.; Cutler, Eli; Barrett, Marguerite L; Levit, Katharine R.; Johann, Jayne; Nicholas, Lauren Hersch; Wong, Herbert S.

doi:10.1177/1077558717692103

Cited by 14 publications

(26 citation statements)

References 21 publications

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“…4 The MA plans use various techniques to control health care utilization, such as restricted practitioner networks, prior authorization, and utilization review, as well as investing in preventive services, care coordination, and chronic disease management. [5][6][7][8][9] There is evidence that MA plans tend to enroll beneficiaries who are healthier than average, and comparisons that use beneficiaries with similar health profiles have found lower health service utilization among MA beneficiaries than among TM beneficiaries. [5][6][7][8] These results have been attributed, in part, to improved care coordination, chronic condition management, provision of low-intensity care, and transitions to less-expensive care settings in MA plans.…”

Section: Introductionmentioning

confidence: 99%

Health Care Utilization, Care Satisfaction, and Health Status for Medicare Advantage and Traditional Medicare Beneficiaries With and Without Alzheimer Disease and Related Dementias

et al. 2020

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IMPORTANCE Compared with traditional Medicare (TM) fee-for-service plans, Medicare Advantage (MA) plans may provide more-efficient care for beneficiaries with Alzheimer disease and related dementias (ADRD) without compromising care quality. OBJECTIVE To determine differences in health care utilization, care satisfaction, and health status for MA and TM beneficiaries with and without ADRD. DESIGN, SETTING, AND PARTICIPANTS A cohort study was conducted of MA and TM beneficiaries with and without ADRD from all publicly available years of the Medicare Current Beneficiary Survey between 2010 and 2016. To address advantageous selection into MA plans, county-level MA enrollment rate was used as an instrument. Data were analyzed between July 2019 and December 2019. EXPOSURES Enrollment in MA. MAIN OUTCOMES AND MEASURES Self-reported health care utilization, care satisfaction, and health status. RESULTS The sample included 47 100 Medicare beneficiaries (25 900 women [54.9%]; mean [SD] age, 72.2 [11.4] years). Compared with TM beneficiaries with ADRD, MA beneficiaries with ADRD had lower utilization across the board, including a mean of −22.3 medical practitioner visits (95% CI, −24.9 to −19.8 medical practitioner visits), −2.3 outpatient hospital visits (95% CI, −3.6 to −1.1 outpatient hospital visits), −0.2 inpatient hospital admissions (95% CI, −0.3 to −0.1 inpatient hospital admissions), and −0.1 long-term care facility stays (95% CI, −0.2 to −0.1 long-term care facility stays). A similar trend was observed among beneficiaries without ADRD, but the difference was greater between MA and TM beneficiaries with ADRD than between MA and TM beneficiaries without ADRD (mean, −15.0 medical practitioner visits [95% CI, −18.7 to −11.3 medical practitioner visits], −1.7 outpatient hospital visits [95% CI, −3.0 to −0.3 outpatient hospital visits], and −0.1 inpatient hospital admissions [95% CI, −1.0 to 0.0 inpatient hospital admissions]). Overall, no or negligible differences were detected in care satisfaction and health status between MA and TM beneficiaries with and without ADRD. CONCLUSIONS AND RELEVANCE Compared with TM beneficiaries, MA beneficiaries had lower health care utilization without compromising care satisfaction and health status. This difference was more pronounced among beneficiaries with ADRD. These findings suggest that MA plans may be delivering health care more efficiently than TM, especially for beneficiaries with ADRD.

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Section: Introductionmentioning

confidence: 99%

Health Care Utilization, Care Satisfaction, and Health Status for Medicare Advantage and Traditional Medicare Beneficiaries With and Without Alzheimer Disease and Related Dementias

et al. 2020

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“…Previous studies have reported lower readmission rates in Medicare Advantage than traditional Medicare (7)(8)(9), leading some policy observers to conclude that Medicare Advantage beneficiaries have better post-acute care outcomes (10). However, these studies have been limited by the lack of complete and accurate data on hospitalizations in Medicare Advantage.…”

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confidence: 99%

Hospital Readmission Rates in Medicare Advantage and Traditional Medicare

et al. 2019

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Background: Medicare's Hospital Readmissions Reduction Program reports risk-standardized readmission rates for traditional Medicare but not Medicare Advantage beneficiaries. Objective: To compare readmission rates between Medicare Advantage and traditional Medicare. Design: Retrospective cohort study linking the Medicare Provider Analysis and Review (MedPAR) file with the Healthcare Effectiveness Data and Information Set (HEDIS).

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“…2,8–10 There is remarkably little evidence about variation in the use of services in the Medicare Advantage (MA) program, which enrolled 31 percent of the Medicare population as of 2016. 11 While private managed care plans are required to provide all Medicare benefits (except for hospice care), they may have the potential to reduce unwarranted variations in care since these entities bear direct financial risk for the cost of services and have tools to constrain utilization that are not fully available in the traditional Medicare program.…”

mentioning

confidence: 99%

Regional Variations: The Use Of Hospitals, Home Health, And Skilled Nursing In Traditional Medicare And Medicare Advantage

Rahman²,

Gozalo

et al. 2018

Health Affairs

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In the traditional Medicare program, the use of health care services—particularly postacute care—varies substantially across geographic regions. Less is known about such variations in Medicare Advantage (MA), which is growing rapidly. Insurers that are paid on a risk basis, as in MA, may have incentives and tools to restrain the use of services, which could attenuate geographic variations. In this study of fifty-four million Medicare beneficiaries in the period 2007–13, we found that geographic variations in the use of skilled nursing facility and hospital care in the MA population exceeded those in traditional Medicare, though variations in the use of home health care were greater in traditional Medicare. Within hospital referral regions, the correlations between the use of services in MA and traditional Medicare were moderate to strong. The findings suggest that regional variations in hospital and postacute care reflect local factors that influence beneficiaries’ use of services irrespective of the way they obtain coverage.

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Medicare Advantage and Traditional Medicare Hospitalization Intensity and Readmissions

Cited by 14 publications

References 21 publications

Health Care Utilization, Care Satisfaction, and Health Status for Medicare Advantage and Traditional Medicare Beneficiaries With and Without Alzheimer Disease and Related Dementias

Health Care Utilization, Care Satisfaction, and Health Status for Medicare Advantage and Traditional Medicare Beneficiaries With and Without Alzheimer Disease and Related Dementias

Hospital Readmission Rates in Medicare Advantage and Traditional Medicare

Regional Variations: The Use Of Hospitals, Home Health, And Skilled Nursing In Traditional Medicare And Medicare Advantage

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