06 Sep Quality of Home Health Agencies in Medicare Advantage Plans

MedicalResearch.com Interview with:

Dr. Rahman

Md Momotazur Rahman PhD
Associate Professor of Health Services, Policy and Practice

Margot Schwartz

Margot Schwartz MPH
Doctoral program

Brown University

MedicalResearch.com: What is the background for this study?

Response: Although one third of Medicare beneficiaries are currently enrolled in Medicare Advantage (MA), it is difficult to assess the quality of healthcare providers that serve MA beneficiaries, or to compare them to providers that serve Traditional Medicare (TM) beneficiaries.

While Medicare Advantage plans are required to cover the same minimum healthcare services as TM, MA beneficiaries receive care from their plan’s network of preferred providers, while TM beneficiaries may select any Medicare-certified provider. The objective of this study is to compare the quality of Home health Agencies (HHAs) that serve Medicare Advantage and TM beneficiaries. Approximately 3.5 million Medicare beneficiaries receive home health care annually.  

MedicalResearch.com: What are the main findings?

Response: We found that Medicare Advantage beneficiaries in both high- and low-quality MA plans receive treatment from lower quality home health agencies (measured in terms of CMS reported star-rating) compared to Traditional Medicare beneficiaries from same ZIP code.  

MedicalResearch.com: What should readers take away from your report?

Response: CMS is trying to facilitate more informed selection of healthcare providers by publicly reporting provider performance measures. However, Medicare Advantage beneficiaries are likely to be constrained by their home health care provider network and end up receiving care from worse quality providers. In fact, HHAs are excluded from Medicare Advantage network adequacy criteria. These criteria regulate the minimum number and accessibility of providers within each MA network. Revision of these criteria, patient awareness and education, and better hospital discharge planning may increase access to higher quality HHAs for Medicare Advantage enrollees. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Receiving care from lower quality HHAs does not necessarily imply that Medicare Advantage patients experience worse health outcomes. Effectively managed and coordinated care by MA plans may compensate for negative effects to admission to lower quality HHAs. Future studies should investigate whether receiving care from lower quality HHAs for Medicare Advantage patients affects patient centered outcomes such as hospital readmission or survival. Additionally, we did not directly observe the HHA selection process. Further research is needed to fully understand the way patients and their families make decisions about home health providers and to facilitate more informed selection.

Disclosures: Ms. Schwartz received consulting fees from BAYADA Home Health Care during the time this research was conducted.

Citation:

Schwartz ML, Kosar CM, Mroz TM, Kumar A, Rahman M. Quality of Home Health Agencies Serving Traditional Medicare vs Medicare Advantage Beneficiaries. JAMA Netw Open. Published online September 04, 20192(9):e1910622. doi:10.1001/jamanetworkopen.2019.10622

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Last Updated on September 6, 2019 by Marie Benz MD FAAD