To examine the effects of Medicare Advantage (MA) enrollment on patterns of end-of-life care.
Aging
Effects of Medicare advantage on patterns of end-of-life care among Medicare decedents
Park S, Teno JM, White L, Coe NB: Effects of Medicare advantage on patterns of end-of-life care among Medicare decedents. Health Services Research 57(4): 863-871, Feb 2022.
Association of Medicare Advantage Penetration With Per Capita Spending, Emergency Department Visits, and Readmission Rates Among Fee-for-Service Medicare Beneficiaries With High Comorbidity Burden
Rapid growth of Medicare Advantage (MA) plans has the potential to change clinical practice for both MA and fee-for-service (FFS) beneficiaries, particularly for high-need, high-cost beneficiaries with multiple chronic conditions or a costly single condition. The authors assessed whether MA growth from 2010 to 2017 spilled over to county-level per capita spending, emergency department visits, and readmission rates among FFS beneficiaries, and how much this varied by the comorbidity burden of the beneficiary. The authors also examined whether the association between MA growth and per capita spending in FFS varied in beneficiaries with specific chronic conditions. MA growth was associated with decreased FFS spending and emergency department visits only among beneficiaries with six or more chronic conditions. MA growth was associated with decreased FFS spending among beneficiaries with 11 of the 20 chronic conditions. This suggests that MA growth may drive improvements in efficiency of health care delivery for high-need, high-cost beneficiaries.
Park S, Langellier BA, Burke RE, Figueroa JF, Coe NB: Association of Medicare Advantage Penetration With Per Capita Spending, Emergency Department Visits, and Readmission Rates Among Fee-for-Service Medicare Beneficiaries with High Comorbidity Burden. Medical Care Research and Review (MCRR) 78(6): 703-712, Dec 2021.
Racial Disparities in Avoidable Hospitalizations in Traditional Medicare and Medicare Advantage
Compared with traditional Medicare (TM), Medicare Advantage (MA) has the potential to reduce racial disparities in hospitalizations for ambulatory care sensitive conditions (ACSC). As racial disparities may be partly attributable to unequal treatment based on where people live, this suggests the need of examining geographic variations in racial disparities. The aim of this study was to examine differences in ACSC hospitalizations between White and Black beneficiaries in TM and MA and examine geographic variations in racial differences in ACSC hospitalizations in TM and MA.
Park S, Fishman P, Coe NB: Racial Disparities in Avoidable Hospitalizations in Traditional Medicare and Medicare Advantage. Medical Care 59(11): 989-966, Nov 2021.
Trends in Receipt of Help at Home After Hospital Discharge Among Older Adults in the US
With declining use of institutional postacute care, more patients are going directly home after hospital discharge. The consequences on the amount of help needed at home after discharge are unknown. This study is to estimate trends in the frequency and duration of receipt of help with activities of daily living (ADLs) among older adults discharged home.
Bressman E, Coe NB, Chen X, Konetzka RT, Werner RM: Trends in Receipt of Help at Home After Hospital Discharge Among Older Adults in the US. JAMA Network Open 4(11): e2135346, Nov 2021.
Differences in Health Care Utilization, Process of Diabetes Care, Care Satisfaction and Health Status in Patients with Diabetes in Medicare Advantage vs Traditional Medicare. Medical Care
The objective of this study was to determine differences in health care utilization, process of diabetes care, care satisfaction, and health status for Medicare Advantage (MA) and traditional Medicare (TM) beneficiaries with and without diabetes. Using the 2010–2016 Medicare Current Beneficiary Survey, the authors identified MA and TM beneficiaries with and without diabetes. To address the endogenous plan choice between MA and TM, the authors used an instrumental variable approach. Using marginal effects, the authors estimated differences in the outcomes between MA and TM beneficiaries with and without diabetes. MA enrollment was associated with lower health care utilization without compromising care satisfaction and health status, particularly for beneficiaries with diabetes. MA may have a more efficient care delivery system for beneficiaries with diabetes.
Park S, Larson EB, Fishman P, White L, Coe NB: Differences in Health Care Utilization, Process of Diabetes Care, Care Satisfaction and Health Status in Patients with Diabetes in Medicare Advantage vs Traditional Medicare. Medical Care 58(11): 1004-1012, Nov 2020.
Health Care Costs of Alzheimer’s and Related Dementias within a Medicare Managed Care Provider
In this study, the authors estimated the direct health care costs attributable to ADRD among older adults within a large MA plan. A retrospective cohort design was used to estimate direct total, outpatient, inpatient, ambulatory pharmacy, and nursing home costs for 3 years before and after an incident ADRD diagnosis for 927 individuals diagnosed with ADRD relative to a sex-matched and birth year-matched set of 2945 controls. The authors found that greater total health care costs among individuals with ADRD are primarily driven by nursing home costs.
Fishman P; White L; Ingraham B; Larson EB; Crane PK; Coe NB: Health Care Costs of Alzheimer’s and Related Dementias within a Medicare Managed Care Provider. Medical Care. Sep 2020. 58(9) 833-841
Dementia Is Associated With Earlier Mortality for Men and Women in the United States
Sociodemographic trends in the United States may influence future dementia-associated mortality, yet there is little evidence about their potential impact. The study objective was to estimate the effect of dementia on survival in adults stratified by sex, education, and marital status. Methods: Using survey data from the Health and Retirement Study (HRS) linked to Medicare claims from 1991 to 2012, the authors identified a retrospective cohort of adults with at least one International Classification of Diseases—ninth revision—Clinical Modification (ICD-9-CM) dementia diagnosis code (n = 3,714). For each case, the authors randomly selected up to five comparators, matching on sex, birth year, education, and HRS entry year (n = 9,531), and assigned comparators the diagnosis date of their matched case. The authors estimated a survival function for the entire study population and then within successive strata defined by sex, education, and marital status. Both sex and level of education moderate the relationship between dementia diagnosis and length of survival.
White L, Fishman P, Basu A, Crane PK, Larson EB, Coe NB. Dementia Is Associated With Earlier Mortality for Men and Women in the United States. Gerontology and Geriatric Medicine, 2020 Aug.
Primary Care Utilization and Expenditures in Traditional Medicare and Medicare Advantage, 2007-2016
Achieving effective, high-quality primary care for Medicare beneficiaries is a national priority as it encourages health promotion and maintenance, potentially reducing intensity of acute care services. Currently, there is ample data documenting intensity of primary care services, including rates of utilization and expenditures, for beneficiaries in fee-for-service Traditional Medicare (TM). However, less is known about the beneficiaries enrolled in Medicare Advantage (MA) plans, which now include 33% of the Medicare population. As managed care’s goal is to control costs while maintaining a high quality, MA plans may encourage greater primary care than is the case in TM. We examined whether this is the case by assessing primary care utilization and expenditures among beneficiaries in MA and TM.
Park S, Figueroa JF, Fishman P, Coe NB: Primary Care Utilization and Expenditures in Traditional Medicare and Medicare Advantage, 2007-2016. Journal of General Internal Medicine 35(8): 2480-2481, Aug 2020.
Health Care Utilization, Care Satisfaction, and Health Status for Medicare Advantage and Traditional Medicare Beneficiaries With and Without Alzheimer Disease and Related Dementias
The purpose of this study was to determine differences in health care utilization, care satisfaction, and health status for Medicare Advantage (MA) and Traditional Medicare (TM) beneficiaries with and without Alzheimer’s Disease and Related Dementias (ADRD). A cohort study was conducted of MA and TM beneficiaries with and without ADRD from all publicly available years of the Medicare Current Beneficiary Survey between 2010 and 2016. To address advantageous selection into MA plans, county-level MA enrollment rate was used as an instrument. Data were analyzed between July 2019 and December 2019. Compared with TM beneficiaries, MA beneficiaries had lower health care utilization without compromising care satisfaction and health status. This difference was more pronounced among beneficiaries with ADRD. These findings suggest that MA plans may be delivering health care more efficiently than TM, especially for beneficiaries with ADRD.
Park S, White L, Fishman P, Larson EB, Coe NB: Health Care Utilization, Care Satisfaction, and Health Status for Medicare Advantage and Traditional Medicare Beneficiaries With and Without Alzheimer Disease and Related Dementias. JAMA Network Open 3(3), Mar 2020.
The Impact of Medicare Copayments for Skilled Nursing Facilities on Length of Stay, Outcomes, and Costs
The purpose of this article was to investigate the impact of Medicare's skilled nursing facility (SNF) copayment policy, with a large increase in the daily copayment rate on the 20th day of a benefit period, on length of stay, patient outcomes, and costs. The authors used retrospective cohort study from 2012 to 2016 including Medicare claims and SNF assessment data, including SNF admissions for Medicare fee-for-service beneficiaries. The authors first estimated how changes in Medicare's SNF copayment on the 21st day of a patient's benefit period affect length of SNF stay. They then then used benefit day on admission as an instrumental variable to estimate the impact of SNF length of stay related to the copayment policy on readmission and Medicare payment. Medicare's SNF copayment policy is associated with shorter lengths of stay and worse patient outcomes, suggesting the copayment policy has unintended and negative effects on patient outcomes.
Werner RM, Konetzka RT, Qi M, Coe NB: The Impact of Medicare Copayments for Skilled Nursing Facilities on Length of Stay, Outcomes, and Costs. Health Services Research 54(6): 1184-1192, Dec 2019.