Home Health And Postacute Care Use In Medicare Advantage And Traditional Medicare

Skopec, Laura; Huckfeldt, Peter J.; Wissoker, Douglas; Aarons, Joshua; Dey, Judith; Oliveira, Iara; Zuckerman, Stephen

doi:10.1377/hlthaff.2019.00844

Cited by 24 publications

(52 citation statements)

References 5 publications

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“… 16 Given that Medicare Advantage plans have been shown to incorporate less home health than traditional Medicare, this factor could have led to reductions in home health use. 23 , 24 However, both ACOs and Medicare Advantage have also been shown to reduce use of skilled nursing facilities, which is inconsistent with our finding of increased use of skilled nursing facility care in the highest- vs lowest-spending regions. 20 , 21 , 25 , 26 Other value-based payment reforms, such as bundled payment and financial penalties for hospital readmissions, had limited or no effect on home health use.…”

Section: Discussioncontrasting

confidence: 95%

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Geographic Variation in Medicare Fee-for-Service Health Care Expenditures Before and After the Passage of the Affordable Care Act

et al. 2021

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IMPORTANCEGeographic variation in Medicare spending is often used as a measure of wasteful spending. A 2013 Institute of Medicine report found that postacute care was a key contributor of geographic variation from 2007 to 2009. However, payment reforms and antifraud efforts implemented after the passage of the Affordable Care Act (ACA) may have reduced geographic variation in spending, especially postacute care spending. OBJECTIVE To investigate how geographic variation in Medicare fee-for-service per-beneficiary spending changed from 2007 to 2018 before and after passage of the ACA.

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Section: Discussioncontrasting

confidence: 95%

“…Advantage plans have been shown to incorporate less home health than traditional Medicare, this factor could have led to reductions in home health use. 23,24 However, both ACOs and Medicare…”

Section: Discussionmentioning

confidence: 99%

Geographic Variation in Medicare Fee-for-Service Health Care Expenditures Before and After the Passage of the Affordable Care Act

et al. 2021

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“…Patients with Medicare Advantage were more likely to receive home health care referrals at hospital discharge compared to fee-for-service beneficiaries, but then were half as likely to receive home health care services. These findings reinforce prior research showing that Medicare Advantage beneficiaries use fewer home health care services [ 44 , 45 , 46 ] and plans have lower expenditures for patients with diabetes than traditional Medicare [ 47 ]. The difference in referral versus utilization observed in our study adds to the literature.…”

Section: Discussionsupporting

confidence: 86%

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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“…Enrollment in MA has grown in recent years, increasing from 13% of total Medicare enrollment in 2004 to 39% in 2020. 11 In comparisons of MA and TM across the care continuum, researchers have found that MA beneficiaries experience lower readmission rates, 12,13 better patient experiences, 14 and lower utilization rates. 15 Policy researchers have suggested that these findings may be driven by a range of factors, including enhanced care coordination, provision of lower intensity care, and transitions to less-expensive care settings in MA.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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Background: Home health use is rising rapidly in the United States as the population ages, the prevalence of chronic disease increases, and older Americans express their desire to age at home. Enrollment in Medicare Advantage (MA) plans rather than Traditional Medicare (TM) has grown as well, from 13% of total Medicare enrollment in 2004 to 39% in 2020. Despite these shifts, little is known about outcomes and costs following home health in MA as compared with TM.Objective: The objective of this study was to measure the association of MA enrollment with outcomes and costs for patients using home health.

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Home Health And Postacute Care Use In Medicare Advantage And Traditional Medicare

Cited by 24 publications

References 5 publications

Geographic Variation in Medicare Fee-for-Service Health Care Expenditures Before and After the Passage of the Affordable Care Act

Geographic Variation in Medicare Fee-for-Service Health Care Expenditures Before and After the Passage of the Affordable Care Act

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

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

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