Roles and Priorities Guiding Medicare Advantage Postacute Home Health Referrals

Home health care (HHC) helps patients-including those recently discharged from the hospital-regain function and maintain independence. The provision of postacute HHC is influenced by multiple players: Medicare Advantage (MA) plans, postacute care management companies (CMCs), hospitals, home health agencies (HHAs), and patients and families. This study sought to characterize the roles and priorities of these players in organizing and delivering postacute HHC.

In-depth, semistructured interviews with 44 leaders of MA plans, CMCs, and HHAs across the US.

Interviews were recorded, transcribed, and analyzed using content analysis.

MA plans and CMCs agreed that home is the ideal setting for postacute care; however, MA plans and CMCs varied in their involvement in referrals, and HHAs viewed their involvement as burdensome (theme 1). According to MA plan, CMC, and HHA leaders, a hospital's role is to select the appropriate postacute care setting, but participants reported that selections can be influenced by relationships with MA plans and HHAs (theme 2). HHAs were reported to balance clinical complexity, staffing, patient location, and payer when accepting referrals, but they had relatively limited control in the referral process (theme 3). Participants expressed that patients prioritized prior experiences, recommendations, quality of care, access, and timeliness when making decisions; however, patients had a minimal role and limited information to guide decision-making (theme 4).

Findings can help policy makers, payers, HHAs, hospitals, and patients understand the varied roles and shared incentives in coordinating postacute HHC for vulnerable older adults.