Background: Medicare Advantage (MA) covers more than 1/3rd of all Medicare beneficiaries. MA plans are required to provide the same benefits as Traditional Medicare (TM), but can impose utilization management tools to control costs. Objective: To assess differences between TM and MA enrollees in the probability of receiving prescribed post-acute home health (HH) care and to describe MA plan characteristics associated with HH receipt. Design: Retrospective cross-sectional analysis of claims data, HH patient assessment data, and MA plan data from 2011 to 2017. Participants: Medicare beneficiaries aged 66 and older with an incident hospitalization for joint replacement, pneumonia, chronic obstructive pulmonary disease, stroke, urinary tract infection, septicemia, acute renal failure, or congestive heart failure. Main Measures: Receipt of prescribed HH as indicated by a HH discharge code and corresponding HH patient assessment within 14 days of hospital discharge. Key Results: There were 2,723,245 beneficiaries prescribed HH at discharge (68% TM, 32% MA). About 75% of TM enrollees and 62% of MA enrollees received prescribed post-acute HH. In adjusted analyses, MA enrollees had an −11.7 percentage point (pp) (95% confidence interval (CI): −16.8, −6.5) lower probability of receiving HH compared with TM enrollees. In adjusted analyses, HMO enrollees in plans with cost sharing (− 8.4 pp; 95% CI: − 14.3, − 2.5), referrals (− 3.7 pp; 95% CI: − 6.1, − 1.2), and pre-authorization (− 5.1 pp; 95% CI: − 8.3, − 2.0) were less likely to receive prescribed HH. In adjusted analyses, PPO enrollees in plans with cost sharing were −7.0 pp (95% CI: − 12.7, − 1.4) less likely to receive HH, but there was no difference for those with referrals (1.1 pp; 95% CI, − 1.5, 3.7) or pre-authorization (1.6 pp; 95% CI: − 0.6, − 3.9). Conclusions: Among Medicare beneficiaries, MA enrollees were less likely to receive prescribed post-acute HH compared with TM. As enrollment in MA continues to grow, it is important to examine how differences in utilization relate to outcomes.
Bibliographical noteFunding Information:
This study was supported by the National Institute on Aging (P01AG027296) and the U.S. Department of Veterans Affairs (CDA 14-422). Role of the Funder/Sponsor
© 2020, Society of General Internal Medicine.
- Medicare Advantage
- home care
- home health
- managed care
- post-acute care