Association of Cost Sharing With Use of Home Health Services Among Medicare Advantage Enrollees

Li, Qijuan; Keohane, Laura M.; Thomas, Kali S.; Lee, Yoojin; Trivedi, Amal N.

doi:10.1001/jamainternmed.2017.1058

Cited by 17 publications

(32 citation statements)

References 12 publications

(17 reference statements)

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“…The difference in referral versus utilization observed in our study adds to the literature. Additional research is needed to identify the causes of these differences, but they may in part be due to cost-containment strategies, including requiring prior authorizations, restricting networks, cost-sharing, and utilization reviews [ 44 , 48 ]. We acknowledge that there is heterogeneity among Medicare Advantage plans [ 44 ] as well as the role healthcare providers play in decision making for post-acute services [ 48 ].…”

Section: Discussionmentioning

confidence: 99%

Racial Disparities in Post-Acute Home Health Care Referral and Utilization among Older Adults with Diabetes

Smith

Jarrín

Lin

et al. 2021

IJERPH

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Racial and ethnic disparities exist in diabetes prevalence, health services utilization, and outcomes including disabling and life-threatening complications among patients with diabetes. Home health care may especially benefit older adults with diabetes through individualized education, advocacy, care coordination, and psychosocial support for patients and their caregivers. The purpose of this study was to examine the association between race/ethnicity and hospital discharge to home health care and subsequent utilization of home health care among a cohort of adults (age 50 and older) who experienced a diabetes-related hospitalization. The study was limited to patients who were continuously enrolled in Medicare for at least 12 months and in the United States. The cohort (n = 786,758) was followed for 14 days after their diabetes-related index hospitalization, using linked Medicare administrative, claims, and assessment data (2014–2016). Multivariate logistic regression models included patient demographics, comorbidities, hospital length of stay, geographic region, neighborhood deprivation, and rural/urban setting. In fully adjusted models, hospital discharge to home health care was significantly less likely among Hispanic (OR 0.8, 95% CI 0.8–0.8) and American Indian (OR 0.8, CI 0.8–0.8) patients compared to White patients. Among those discharged to home health care, all non-white racial/ethnic minority patients were less likely to receive services within 14-days. Future efforts to reduce racial/ethnic disparities in post-acute care outcomes among patients with a diabetes-related hospitalization should include policies and practice guidelines that address structural racism and systemic barriers to accessing home health care services.

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Section: Discussionmentioning

confidence: 99%

Racial Disparities in Post-Acute Home Health Care Referral and Utilization among Older Adults with Diabetes

Smith

Jarrín

Lin

et al. 2021

IJERPH

View full text Add to dashboard Cite

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“…Previous research found that Medicare Advantage beneficiaries use fewer home health care services [39][40][41] and plans have lower expenditures for patients with diabetes than traditional Medicare [42]. These differences may in part be due to cost-containment strategies including requiring prior authorizations, restricting networks, cost-sharing, and utilization reviews [41,43]. We acknowledge that there is heterogeneity among Medicare Advantage plans [39] as well as the role healthcare provider's play in decision making for post-acute services [43].…”

Section: Discussionmentioning

confidence: 99%

“…These differences may in part be due to cost-containment strategies including requiring prior authorizations, restricting networks, cost-sharing, and utilization reviews [41,43]. We acknowledge that there is heterogeneity among Medicare Advantage plans [39] as well as the role healthcare provider's play in decision making for post-acute services [43]. These findings are relevant as enrollment in Medicare Advantage increases, today 36% of Medicare beneficiaries are in a Medicare Advantage plan, from 24% a decade ago [44].…”

Section: Discussionmentioning

confidence: 99%

Racial Disparities in Post-Acute Home Health Care Referral and Utilization Among Older Adults with Diabetes

Smith¹,

Jarrín²,

Lin³

et al. 2021

Preprint

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Racial and ethnic disparities exist in diabetes prevalence, health services utilization, and out-comes including disabling and life-threatening complications. Home health care may especially benefit older adults with diabetes through individualized education, advocacy, care coordina-tion, and psychosocial support for patients and their caregivers. This study examined factors as-sociated with hospital discharge to home health care and subsequent utilization of home health care among a cohort of Medicare beneficiaries with diabetes, age 50 and older, living in the United States. The cohort (n=786,758) was followed for 14 days after a diabetes-related index hospitalization, using linked Medicare administrative, claims, and assessment data (2014-2016). Multivariate logistic regression models included patient demographics, comorbidities, hospital length of stay, geographic region, neighborhood area deprivation, and rural/urban setting. In ful-ly adjusted models, hospital discharge to home health care was significantly less likely among Hispanic (OR 0.8, 95% CI 0.8-0.8) and American Indian (OR 0.8, CI 0.8-0.8) compared to white patients. Among those discharged to home health care, all racial/ethnic minority patients were less likely to receive services within 14-days. Further work should focus on eliminating systemic racism in home health care referral and systemic barriers to receiving home health care services.

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“…Our study improves upon this study by examining an exogenous reason for cost sharing changes, rather than voluntary cost sharing changes that plans that want to influence SNF use may choose. Our null result parallels recent findings suggesting that home health cost sharing did not affect service use of MA members …”

Section: Discussionmentioning

confidence: 99%

Effects of Caps on Cost Sharing for Skilled Nursing Facility Services in Medicare Advantage Plans

Keohane

Rahman

Thomas

et al. 2018

J American Geriatrics Society

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OBJECTIVES To evaluate a federal regulation effective in 2011 that limited how much that Medicare Advantage (MA) plans could charge for the first 20 days of care in a skilled nursing facility (SNF). DESIGN Difference-in-differences retrospective analysis comparing SNF utilization trends from 2008–2012. SETTING Select MA plans. PARTICIPANTS Members of 27 plans with mandatory cost sharing reductions (n=132,000) and members of 21 plans without such reductions (n=138,846). MEASUREMENTS Mean monthly number of SNF admissions and days per 1,000 members; annual proportion of MA enrollees exiting the plan. RESULTS In plans with mandated cost sharing reductions, cost sharing for the first 20 days of SNF care decreased from an average of $2,039 in 2010 to $992 in 2011. In adjusted analyses, plans with mandated cost-sharing reductions averaged 158.1 SNF days (95% confidence interval (CI)=153.2–163.1 days) per 1,000 members per month before the cost sharing cap. This measure increased by 14.3 days (95% CI=3.8–24.8 days, p=0.009) in the 2 years after cap implementation. However, increases in SNF utilization did not significantly differ between plans with and without mandated cost-sharing reductions (adjusted between-group difference: 7.1 days per 1,000 members, 95% CI=−6.5–20.8, p=.30). Disenrollment patterns did not change after the cap took effect. CONCLUSIONS When a federal regulation designed to protect MA members from high out-of-pocket costs for postacute care took effect, the use of SNF services did not change.

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Association of Cost Sharing With Use of Home Health Services Among Medicare Advantage Enrollees

Cited by 17 publications

References 12 publications

Racial Disparities in Post-Acute Home Health Care Referral and Utilization among Older Adults with Diabetes

Racial Disparities in Post-Acute Home Health Care Referral and Utilization among Older Adults with Diabetes

Racial Disparities in Post-Acute Home Health Care Referral and Utilization Among Older Adults with Diabetes

Effects of Caps on Cost Sharing for Skilled Nursing Facility Services in Medicare Advantage Plans

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