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Home-Based Medical Care Use In Medicare Advantage And Traditional Medicare In 2018
Jeffrey Marr1, Christine Ritchie2, Bruce Leff3
1Jeffrey Marr (jmarr5@jhu.edu), Johns Hopkins University, Baltimore, Maryland.
Insights
Medicare Advantage beneficiaries were significantly more likely to have one home-based medical care visit compared to traditional Medicare beneficiaries in 2018. This difference may reflect coding incentives within Medicare Advantage plans.
Area of Science:
- Health Services Research
- Medicare Policy
- Home-Based Medical Care Utilization
Background:
- Medicare Advantage and traditional Medicare represent distinct pathways for accessing healthcare services.
- Understanding variations in utilization patterns, such as home-based medical care, is crucial for evaluating program effectiveness and equity.
- Previous research has not fully elucidated the differences in home-based care use between these two Medicare models.
Purpose of the Study:
- To compare the utilization of home-based medical care services between beneficiaries enrolled in Medicare Advantage and traditional Medicare.
- To identify potential factors, such as program incentives, that may explain observed differences in care utilization.
Main Methods:
- Retrospective analysis of 2018 Medicare claims data.
- Comparison of the prevalence of beneficiaries utilizing at least one home-based medical care visit.
- Stratification of analysis by the number of home-based medical care visits (exactly one vs. multiple).
Main Results:
- In 2018, 18.6% of Medicare Advantage beneficiaries had exactly one home-based medical care visit, compared to only 0.6% of traditional Medicare beneficiaries—a 31-fold difference.
- The higher likelihood of a single visit in Medicare Advantage may be linked to program incentives for accurate diagnosis coding.
- Conversely, multiple home-based medical care visits were less common in Medicare Advantage (1.6%) than in traditional Medicare (2.1%).
Conclusions:
- Significant disparities exist in the patterns of home-based medical care utilization between Medicare Advantage and traditional Medicare.
- Medicare Advantage's structure, potentially including coding incentives, appears to influence the reporting of single home-based care episodes.
- Further investigation is warranted to understand the clinical implications and patient outcomes associated with these utilization differences.
Abstract:
The use of home-based medical care differed in Medicare Advantage and traditional Medicare in 2018. Having exactly one such visit was thirty-one times as likely for Medicare Advantage beneficiaries (18.6 percent) as for traditional Medicare beneficiaries (0.6 percent), likely reflecting incentives in the Medicare Advantage program to code all accurate diagnoses. Multiple home-based medical care visits were less likely in Medicare Advantage than in traditional Medicare (1.6 percent versus 2.1 percent of beneficiaries, respectively).
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