Blog | Value-Based Payment

Study: Medicare Advantage enrollees less likely than traditional Medicare enrollees to use both institutional post-acute care and home health care

Blog | Value-Based Payment

Study: Medicare Advantage enrollees less likely than traditional Medicare enrollees to use both institutional post-acute care and home health care

  • Following hospitalizations for joint replacement, stroke or heart failure, MA enrollees were less likely than traditional Medicare enrollees to use both institutional post-acute care and home health care, and more likely to be discharged to the community without post-acute care, according to a study published in Health Affairs.
  • MA enrollees who used institutional care received fewer days of care than traditional Medicare enrollees did, according to the same article.
  • The Health Affairs article also reported that MA enrollees had lower thirty- and ninety-day hospital readmission rates than traditional Medicare enrollees across the conditions studied. MA enrollees had slightly higher ninety-day mortality rates than traditional Medicare enrollees following joint replacements and strokes.

The results of a study published in the recent Health Affairs’ article “Home Health And Postacute Care Use In Medicare Advantage And Traditional Medicare” finds that, “Following hospitalizations for joint replacement, stroke, or heart failure, MA enrollees were less likely than traditional Medicare enrollees to use both institutional postacute care and home health care and more likely to be discharged to the community without postacute care. In addition, MA enrollees who used institutional care received fewer days of care than traditional Medicare enrollees did. MA enrollees had lower thirty- and ninety-day hospital readmission rates than traditional Medicare enrollees did across the conditions studied. MA enrollees had slightly higher ninety-day mortality rates than traditional Medicare enrollees following joint replacements and strokes.”

Takeaway

The results of this study are not surprising. From my work with organization’s implementing Advanced Alternative Payment Models, I’ve seen similar analysis at the market level comparing one Medicare Advantage (MA)  plan’s risk adjusted institutional Post-Acute Care (PAC) utilization to Medicare Fee-For-Service (FFS) patients.

The MA plan aggressively managed its members’ PAC lengths-of-stay, and as a result, they had 30% to 50% lower utilization than the FFS population, depending on the market with relatively similar outcomes metrics on readmissions and mortality.

Providers participating in APMs in Medicare FFS don’t have the ability to deploy aggressive utilization management tactics to ensure patients are discharged to the most-appropriate first PAC setting and assure that institutional LOS aren’t longer than clinically necessary. However, where there is a competition for PAC discharges, they can form partnerships with high-quality PAC providers who have similar interests in improving patient outcomes.

Resources on developing high-value PAC networks

Last summer, HFMA published two articles providing an overview of the steps organizations have taken to develop and operationalize high-value PAC networks:

About the Author

Chad Mulvany, FHFMA,

is director, healthcare finance policy, strategy and development, HFMA’s Washington, D.C., office.

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