Some Medicare Advantage plans may not provide enough post-acute care because they want to save money and work more efficiently. A new study in JAMA Health Forum says that traditional Medicare, on the other hand, often offers more intensive care after an acute hospital stay, which leads to better long-term health results.
The study found that MA enrollees had the same health outcomes as standard Medicare beneficiaries, even though they got less intensive post-acute care. The rates of death and hospital readmissions after 30 days were about the same for both groups.
The researchers looked at more than 4,600 hospital visits by retired people from Ohio. Ohio retirees who worked for the government in 2016 could choose to stay with their health insurance through a Humana group MA plan or switch to regular Medicare. Seventy-five percent moved to the old Medicare plan. Researchers looked at claims from both groups and found that MA plans were less likely than traditional Medicare to cover home health or more intensive post-acute treatments after a hospital stay.
And retirees with traditional Medicare were more likely than MA beneficiaries to get extra services on top of home health care after a hospital stay. These extra services could be expensive, like care in a rehabilitation center.
A study says that tools like prior permission and carefully chosen provider networks help MA plans provide better care. However, these tools may also encourage some insurers to cut corners in order to save money. Plans that use “case management” to match patients with the best type of post-acute care can make it harder for them to get important services. These problems can only be fixed with “extensive effort, persistence, and clinical justification.” They also said that in order to cut costs, MA plans might focus on services that keep people healthy in the short term while ignoring more expensive services that improve health in the long term.
The report said, “MA plans save money by cutting back on PAC use, which may have negative effects on patients and caregivers.” “Another worry about the lower use of inpatient rehabilitation facilities in Massachusetts is that people who would benefit from more intensive rehabilitation services might not be able to get them.”
