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Methodological Approaches to Examining Home Health Using Traditional Medicare and Medicare Advantage Claim Data
Jianhui Xu1, Jamie M Smith2, Julia G Burgdorf3
1Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
Health Services Research
|February 5, 2026
Summary
A new method uses Medicare claims to track home health stays, showing it works for both Traditional Medicare and Medicare Advantage plans before and after the Patient-Driven Groupings Model. This allows for direct utilization comparisons.
Area of Science:
- Health Services Research
- Medicare Policy
- Home Healthcare Analytics
Background:
- Traditional Medicare (TM) and Medicare Advantage (MA) have distinct data sources for home health utilization.
- Standardized methodologies are needed to compare healthcare utilization across different Medicare populations.
- The Patient-Driven Groupings Model (PDGM) impacted home health payment and service delivery.
Purpose of the Study:
- To develop and validate a claims-based methodology for identifying new home health stays.
- To enable direct comparisons of home health utilization between TM and MA beneficiaries.
- To assess the methodology's feasibility before and after the PDGM implementation.
Main Methods:
- Utilized Traditional Medicare (TM) claims and Medicare Advantage (MA) encounter data from 2019 and 2021.
- Constructed a methodology to identify new home health stays using claims data.
- Analyzed beneficiary percentages with one or more stays and mean length of stay (LOS).
Main Results:
- In 2019, TM had a slightly higher percentage of beneficiaries with new home health stays (6.5%) compared to MA (5.9%).
- Approximately 90% of home health recipients in both TM and MA had a single stay.
- Mean LOS was 44 days for TM and 39 days for MA in 2019, increasing to 46 days for TM in 2021.
Conclusions:
- The claims-based methodology is feasible for constructing new home health stays in both TM and MA.
- The methodology performs reliably both pre- and post-PDGM implementation.
- This approach facilitates direct comparisons of home health utilization across TM and MA populations.
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