When it comes to Medicare Advantage (MA) versus traditional Medicare, members of the former generally use less home health care and post-acute care.
This is the result of a current analysis by the Kaiser Family Foundation (KFF). The analysis examines 62 studies looking at the experiences of MA and traditional Medicare beneficiaries, including utilization.
Overall, MA enrollments have increased over the decade. In 2010, 25% of the eligible Medicare population were MA members. Now it’s almost half of the Medicare population.
Additionally, beneficiaries who are eligible for Medicare and Medicaid make up a growing proportion of the MA population.
The KFF analysis examined 34 studies that compared the use of health services between MA participants and traditional Medicare recipients. Of these, KFF studied 18 that specifically focused on post-acute care and home nursing.
“The analyzes have consistently shown that [MA] Participants had higher utilization of preventive services and lower utilization of post-acute and home healthcare services,” KFF wrote in the analysis.
Looking across the various studies, home health care utilization among MA participants was 2.4% to 6% lower with MA than with traditional Medicare.
The analysis also showed that both high-need and non-high-need MA enrollers were less likely to use home healthcare services. Individuals with three or more chronic conditions and limitations in ADLs are considered high need beneficiaries.
Three of the studies on which KFF based its analysis examined users of home healthcare services and hospitalization rates. There are lower rates of hospitalizations among MA enrollments, but there have been conflicting results on other outcome measures.
Additionally, MA students were less likely to receive nursing services from home care providers with the highest quality ratings.
While the analysis doesn’t explain the lower utilization of home healthcare services among MA enrollments, it does provide an indication as to why this might be happening.
Erin Bliss, Assistant Inspector General of the US Department of Health and Human Services (HHS), noted that MA sometimes delays or denies access to care for beneficiaries, even when it is medically necessary and compliant with Medicare coverage rules.
“In other words, these Medicare Advantage beneficiaries were denied access to needed services that would likely have been approved had the beneficiary been enrolled in original Medicare,” Bliss said during a June hearing centered on the MA- program turned. “These denials likely prevented or delayed the required care of the beneficiaries.”
The analysis also comes at a time when providers have had a recent opportunity to share their views on how MA is currently administered by the US Centers for Medicare & Medicaid Services (CMS).
“CMS is beginning to more accurately evaluate the plans in terms of provider relationships and approaches to enrolled health care and how the plans can improve health services for these beneficiaries,” said Mary Carr, vice president of regulatory affairs at NAHC. previously Home Health Care News.
In their comments, Washington, DC-based advocacy group Moving Health Home urged CMS to push MA plans to allow access to home care through the network’s adequacy standards.
“The scope could focus on specific specialties where home care is appropriate, or on specific patient populations that could benefit most from home care, such as: B. expensive patients with high needs,” the organization wrote. “The existing process for requesting an exemption from network adequacy requirements should be maintained for those plans who cannot provide home care or who believe it is inappropriate for their patient populations.”