Community-Entry Home Health Made Up Nearly Half Of Home Health Episodes And Spending In Traditional Medicare, 2017-21

Area of Science:

• Health Services Research
• Gerontology
• Public Health Policy

Background:

• Medicare home health care is primarily viewed as a postacute care benefit.
• Community-entry home health users, admitted without prior hospitalization, constitute a significant portion of Medicare spending and episodes.

Purpose of the Study:

• To analyze the demographic and clinical differences between community-entry and postacute home health users in traditional Medicare.
• To investigate the relationship between community-entry prevalence, home health utilization, and spending patterns.

Main Methods:

• Analysis of traditional Medicare administrative data from 2017, 2019, and 2021.
• Comparison of clinical characteristics (age, dual eligibility, cognitive impairment, Alzheimer's disease, depression) and visit patterns between user groups.
• Examination of state-level variations in community-entry prevalence and its association with spending.

Main Results:

• Community-entry beneficiaries were older, more likely dually eligible, and had higher rates of cognitive impairment, Alzheimer's disease, and depression compared to postacute users.
• Despite clinical differences, home health visit patterns were similar across both user groups.
• Significant state-level variation in community-entry prevalence was observed, positively correlating with overall home health spending.

Conclusions:

• Medicare home health care serves a substantial population of community-entry users with distinct clinical and demographic profiles, challenging its sole characterization as a postacute benefit.
• The findings highlight a policy-practice gap, indicating that current Medicare home health policies may not fully align with the needs of the diverse user population.
• Understanding these differences is crucial for optimizing home health resource allocation and policy development.