Home Care

Medicare Advantage Lacking In Home Care

Medicare Advantage

A study in JAMA Health Forum stirred the pot ahead of a busy HIMSS week by suggesting that Medicare Advantage patients are getting skimped on home care.

Researchers conducted a cross-sectional study of 178k traditional Medicare and 107k Medicare Advantage patients, analyzing those who had care between 2019 and 2022.

Compared to their Medicare counterparts, MA patients:

  • Saw shorter home health lengths of stay (-1.62 days)
  • Saw fewer nursing, therapy, and aide visits (social work was the only exception)
  • Had 3% lower odds of improving mobility
  • Had 4% lower odds of improving self-care metrics
  • Were 5% more likely to be discharged to the community

While home health isn’t a massive focus for most MA plans, it’s an important resource for keeping patients out of nursing facilities or other long-term care.

  • MA beneficiaries are also more likely to live alone and without a large support network, so the fact that they’re getting discharged to the community more frequently – combined with less mobility improvement – isn’t a great recipe for success.

The study doesn’t dive into the cause behind the discrepancies, but whether the differences are due to the administrative burden or cost-limiting incentives of MA plans, the negative implications for patients are clear. Less functional independence, and more caregiver burden.

The Takeaway

With over half of Medicare beneficiaries now enrolled in MA plans, there’s a growing concern over how the plans are operated, and whether the fences they set up around coverage are limiting access to treatment. All-in-all, this study seems to validate that concern, and reinforces the need for keeping a close eye on outcomes as MA enrollment continues its upward trajectory.

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