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

Area of Science:

• Health Services Research
• Health Economics
• Gerontology

Background:

• Home health care is a Medicare benefit for homebound individuals needing skilled care.
• Home health care can prevent costly institutionalization, but overuse is a concern in traditional Medicare.
• Variations in home health utilization exist between Medicare Advantage and traditional Medicare.

Purpose of the Study:

• To compare home health care utilization between Medicare Advantage (MA) and traditional Medicare (TM).
• To examine factors influencing home health use within MA plans, including cost-sharing and prior authorization.
• To inform potential policy changes in traditional Medicare payment to reduce utilization disparities.

Main Methods:

• Comparative analysis of home health care use in MA versus TM enrollees in 2016.
• Subgroup analysis within MA plans based on cost-sharing, prior authorization, and plan type.
• Qualitative interviews to understand MA payment and contracting influences on home health use.

Main Results:

• MA enrollees showed lower home health care use and shorter spell lengths compared to TM enrollees.
• MA enrollees experienced fewer hospital admissions during home health spells.
• MA plans with cost-sharing or prior authorization requirements demonstrated reduced home health utilization.

Conclusions:

• Medicare Advantage plans exhibit lower home health care utilization than traditional Medicare.
• Cost-sharing and prior authorization in MA plans are associated with decreased home health use.
• Upcoming traditional Medicare payment policy changes may mitigate existing disparities in home health care utilization.