Home Health Use In Medicare Advantage Compared To Use In Traditional Medicare

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

doi:10.1377/hlthaff.2019.01091

Cited by 21 publications

(61 citation statements)

References 10 publications

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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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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

View full text Add to dashboard Cite

show abstract

“…Patients with Medicare Advantage were more likely to receive home health referrals at hospital discharge compared to fee-for-service beneficiaries, but then were half as likely to receive home health services. 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].…”

Section: Discussionmentioning

confidence: 99%

“…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%

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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“…Most of the home health deficit in MA plans was in plans that required prior authorization for such services. 18…”

Section: Medicare Advantagementioning

confidence: 99%

Health Care Crisis Unabated: A Review of Recent Data on Health Care in the United States

Himmelstein

Woolhandler

2020

Int J Health Serv

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We review recently published studies of U.S. health policy and the nation’s health care system. Even prior to the COVID-19 pandemic, health inequalities were widening and care was inequitably distributed. Although the Affordable Care Act’s coverage expansion improved access to care and timely cancer diagnoses, a large proportion of U.S. residents continued to avoid medical care due to concerns about costs, and access to mental health services remains particularly inadequate. Yet more evidence of private insurers’ profit-driven misbehaviors and of corruption among medical leaders continues to emerge. Misguided incentives and lax regulation encourages nominally nonprofit health care providers to mimic for-profits’ misconduct, and rapacious investors own and control an increasing share of physicians’ practices. Pharmaceutical firms wield outsize political influence and devote far more funds to rewarding investors than to research and development effort. Yet despite vigorous efforts by pharma and other commercial interests to denigrate national health insurance, polls indicate that the COVID-19 pandemic has led to increasing support for such reform.

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Home Health Use In Medicare Advantage Compared To Use In Traditional Medicare

Cited by 21 publications

References 10 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

Health Care Crisis Unabated: A Review of Recent Data on Health Care in the United States

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