In March, a study published in the Journal of the American Medical Association contributed to the growing body of research indicating that patients enrolled in Medicare Advantage experience poorer outcomes compared to those in traditional Medicare, particularly in post-acute care settings. Dr. Prusynski and colleagues conducted an analysis of data from over 285,000 home health patients, spanning from 2019 to 2022. Their findings revealed that Medicare Advantage patients received fewer days of home health services, fewer nursing, therapy, and aide visits, and exhibited lower rates of improvement in mobility and self-care. Despite their lower functional status, Medicare Advantage patients were more frequently discharged to the community. These findings align with prior research, which has consistently shown shorter lengths of stay and less functional improvement among home health patients covered by Medicare Advantage plans.^2-4

Medicare Advantage

Integrating home health services into a care plan has been associated with positive outcomes such as reduced mortality, fewer readmissions, and improved functional abilities. However, as the population of Medicare Advantage beneficiaries continues to surpass that of traditional Medicare, concerns have arisen regarding the practices of Medicare Advantage plans. These plans often restrict healthcare utilization through mechanisms such as cost-sharing, limited provider networks, and prior authorization, none of which are present in traditional Medicare’s coverage of home health services. Furthermore, the way in which these plans bundle and market their benefits tends to attract younger and healthier individuals, leaving traditional Medicare with a disproportionately higher number of patients with greater healthcare needs.

Lower Utilization Rates

Unfortunately, Medicare Advantage patients tend to have lower utilization rates of institutional care⁵ and home health services⁶, are more likely to receive care from low-rated agencies⁷, be admitted to low-quality skilled nursing facilities, face higher out-of-network costs, and experience limited access to specialists. Studies have even shown that Medicare Advantage patients with conditions like stroke or joint replacements are at a higher risk of mortality.³

In the current study, one limitation in methodology likely underestimated the disparities between different coverage types. While the patients came from 19 states and over 100 home health agencies, all these agencies belonged to the same company, which may have mitigated the impact of lower-quality agencies commonly found in Medicare Advantage networks and practices.

In Conclusion

The researchers concluded that patients on MA had a shorter length of stay (LOS) for home health, had fewer visits by their home health, and had lower rates of improving self-care. Independence and caregiver burden in patients with MA could be influenced by these results. The study underscores the importance of evaluating programs and policies that deter home healthcare utilization, including Medicare Advantage, with a focus on functional outcomes to mitigate potential adverse effects on patient well-being.

References:

1. Prusynski RA, D’Alonzo A, Johnson MP, Mroz TM, Leland NE. Differences in Home Health Services and Outcomes Between Traditional Medicare and Medicare Advantage. In JAMA Health Forum 2024 Mar 1 (Vol. 5, No. 3, pp. e235454-e235454). American Medical Association.
2. Achola EM, Stevenson DG, Keohane LM. Postacute care services use and outcomes among traditional Medicare and Medicare Advantage beneficiaries. In JAMA Health Forum 2023 Aug 4 (Vol. 4, No. 8, pp. e232517-e232517). American Medical Association.
3. Skopec L, Zuckerman S, Aarons J, Wissoker D, Huckfeldt PJ, Feder J, Berenson RA, Dey J, Oliveira I. Home Health Use In Medicare Advantage Compared To Use In Traditional Medicare: Study compares home health use in Medicare Advantage and traditional Medicare by beneficiary cost sharing, prior authorization requirement, and plan type. Health Affairs. 2020 Jun 1;39(6):1072-9.
4. Waxman DA, Min L, Setodji CM, Hanson M, Wenger NS, Ganz DA. Does Medicare Advantage enrollment affect home healthcare use. Am J Manag Care. 2016 Nov 1;22(11):714-20.
5. Schwartz R, Caplan A, Casebeer A, Erwin CJ, Shrank WH, Powers BW. Comparison of health care utilization by Medicare Advantage and traditional Medicare beneficiaries with complex care needs. In JAMA Health Forum 2022 Oct 7 (Vol. 3, No. 10, pp. e223451-e223451).
6. Research Institute for Home Care. Home care chartbook 2023. Accessed Mach 19, 2024. https://researchinstituteforhomecare.org/wp-content/uploads/Final-RIHC-Chartbook-2023-1.pdf
7. Schwartz ML, Kosar CM, Mroz TM, Kumar A, Rahman M. Quality of Home Health Agencies Serving Traditional Medicare vs Medicare Advantage Beneficiaries. JAMA Network Open. 2019 Sep 4;2(9):e1910622-.