A recent article published in JAMA Health Forum has emphasized the critical need to integrate feedback from patients into the formulation of policies related to post-acute care within the Medicare Advantage (MA) system. The study, carried out by researchers from Vanderbilt University Medical Center, highlights the necessity for MA programs to actively seek input from beneficiaries to evaluate the effectiveness of post-acute care in their recovery process after being discharged from the hospital.
The study’s findings indicated that, overall, beneficiaries enrolled in MA plans utilized fewer post-acute care services compared to their counterparts enrolled in the traditional Medicare program. However, these beneficiaries also reported less favorable outcomes from the post-acute care they received. This revelation holds significant implications, particularly as the landscape of MA continues to evolve. Health insurers responsible for managing these plans are actively seeking ways to optimize and streamline the perceived inefficiencies associated with post-acute care services.
It was disclosed in the study that fee-for-service Medicare allocated approximately $57 billion towards post-acute care services in the year 2020. Emma Achola, the lead researcher, stressed that this research underscores the urgency for MA plans to address any gaps in patient satisfaction. This effort is crucial to ensure that patients receive appropriate care at the most opportune time during their recovery journey.
Prior research studies, cited within this study, have shown that beneficiaries of MA plans experience successful transitions to community-based care after their hospitalization. Furthermore, these beneficiaries tend to have longer stays in community settings following discharge compared to individuals under the traditional Medicare program. While the differences in mortality rates between MA and Medicare beneficiaries were not statistically significant, MA enrollees displayed a reduced likelihood of readmission to hospitals.
However, the study also issues a word of caution, urging against relying solely on administrative data from past research endeavors. The study argues that evaluating patient-reported outcomes is crucial for a comprehensive understanding of the effectiveness of the MA program in meeting the needs of its beneficiaries. This perspective gains added prominence given existing evidence suggesting that MA enrollees might experience lower-quality care in skilled nursing facilities.
To gather the necessary data for their analysis, researchers drew from the National Health and Aging Trends Study, utilizing self-reported measures related to the utilization and outcomes of post-acute care. The data was collected through interviews conducted between 2015 and 2017. Study participants were individuals aged 70 and above, living in community settings rather than nursing homes. The study aimed to minimize hidden disparities between the MA and traditional Medicare populations by selecting individuals with similar health conditions who were more likely to utilize post-acute care.
The study emphasized that MA achieved cost savings through its analysis of administrative data within the Medicare Shared Savings Program, along with the implementation of mandatory bundled payment strategies. These interventions showed promise in reducing the utilization of post-acute care without adverse consequences. Nevertheless, the study suggests that MA plans should directly engage patients in evaluating care quality and investigating any potential declines in patient satisfaction scores.
The study also highlighted a potential correlation between variations in perceived improvements and the utilization management practices within MA plans. For instance, requiring prior authorization for accessing post-acute services could lead to delays in beneficiaries receiving necessary treatments or prematurely terminating services before beneficiaries fully benefit.
