MA enrollees are less likely to receive care from high-quality home health providers

When it comes to Medicare Advantage (MA) versus traditional Medicare, members of the former use less home health care and post-acute care overall.

This is according to a recent analysis by the Kaiser Family Foundation (KFF). The analysis looked at 62 studies that looked at the experiences of MA and traditional Medicare beneficiaries, including utilization.

Overall, graduate enrollment increased throughout the decade. In 2010, graduate enrollment accounted for 25% of the Medicare eligible population. Now that’s almost half the Medicare population.

Additionally, beneficiaries who are eligible for both Medicare and Medicaid make up a growing share of the MA population.

The KFF analysis examined 34 studies that compared health care utilization between MA enrollees and traditional Medicare beneficiaries. Of these, KFF looked at 18 that focused on post-acute care and specifically home health care.

“Analysis consistently finds this [MA] enrollees had higher use of preventive services and lower use of post-acute care and home health services,” KFF wrote in the analysis.

When looking across studies, home health care utilization among MA enrollees was 2.4% to 6% lower with MA compared with traditional Medicare.

The analysis also showed that both high-need and non-high-need graduate enrollees were less likely to use home health services. Individuals who have three or more chronic conditions and ADL limitations are considered high-needs beneficiaries.

Three of the KFF studies based their analysis on home health care users and hospitalization rates. There are lower rates of hospitalization among MA enrollees, but there were conflicting findings on other outcome measures.

In addition, MA enrollees were less likely to receive care services from home health providers with the highest quality ratings.

Although the analysis does not explain the lower use of home health services among MA enrollees, it provides insight into why this may be occurring.

Erin Bliss, assistant inspector general of the US Department of Health and Human Services (HHS), pointed out that sometimes MA plans delay or deny beneficiaries access to care, even when it is medically necessary and meets the coverage rules of Medicare.

“In other words, these Medicare Advantage beneficiaries were denied access to necessary services that would likely have been approved had the beneficiary been enrolled in original Medicare,” Bliss said during a hearing centered around the master’s program in June. “These denials likely prevented or delayed needed care for beneficiaries.”

The analysis also comes as providers recently had an opportunity to voice their views on how MA is currently administered by the US Centers for Medicare & Medicaid Services (CMS).

“CMS is beginning to evaluate plans more closely in terms of provider relationships and approaches to providing health care to enrollees and how plans can improve health care services for these beneficiaries,” said Mary Carr, vice president of regulatory affairs at NAHC. Home Health News.

In its comments, the Washington-based advocacy coalition Moving Health Home urged CMS to require MA plans to provide access to home care through network adequacy standards.

“Outreach may focus on certain specialties where home care is appropriate, or on specific patient populations that may benefit most from home care, such as high-cost patients with high needs,” the organization wrote. “The existing process for requesting an exception to network adequacy requirements should remain for those plans that are unable to offer home care or that believe it is inappropriate for their patient populations.”

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