Aging

Association of Medicare Advantage Star Ratings With Racial and Ethnic Disparities in Hospitalizations for Ambulatory Care Sensitive Conditions

Enrollment in high-quality Medicare Advantage (MA) plans, measured by a 5-star quality rating system, was lower among racial and ethnic minority enrollees than White enrollees partly due to fewer high-quality plans available in their counties of residence. This may contribute to racial and ethnic disparities in ambulatory care sensitive condition (ACSC) hospitalizations. We examined whether there were racial and ethnic disparities in ACSC hospitalizations among MA enrollees overall and by star rating.

Park S, Werner RM, Coe NB: Association of Medicare Advantage Star Ratings with Racial and Ethnic Disparities in Hospitalizations for Ambulatory Care Sensitive Conditions. Medical Care 60(12): 872-879, Dec 2022.

Association of Medicare Advantage star ratings with patterns of end-of-life care

No abstract available

Park S, Teno JM, White L, Coe NB: Association of Medicare Advantage star ratings with patterns of end-of-life care. Journal of the American Geriatrics Society Sep 2022 Notes: Online ahead of print.

Growth of Private Pay Senior Housing Communities in Metropolitan Statistical Areas in the United States: 2015-2019

Older adults needing assistance with activities of daily living can receive support in various settings. Senior housing communities, such as independent living, assisted living, and continuing care retirement communities, are an increasingly popular option for adults not requiring nursing home-level care. However, limited research exists due to a dearth of data on these types of communities. We use a proprietary data set to describe the market of private pay senior housing and community-level characteristics in 140 metropolitan statistical areas, from 2015 to 2019. Although the number of senior housing communities increased substantially, the supply of senior housing options supporting the continuum of care has not necessarily kept up with population growth. Describing the supply of senior housing communities across the spectrum of levels of care provides a more complete description of the formal noninstitutional long-term care supply among the 140 most populated metropolitan statistical areas.

Miller KE, Zhao Jiayi, Laine LT, Coe NB: Growth of Private Pay Senior Housing Communities in Metropolitan Statistical Areas in the United States: 2015-2019. Medical care research review (MCRR) Jul 2022 Notes: Online ahead of print.

The value of an additional day of post-acute care in a skilled nursing facility

With ongoing efforts to improve the value of health care in the U.S. and reduce wasteful spending, we examine empirically the value tradeoffs involved in an additional day in a skilled nursing facility (SNF) after hospital discharge. To control for potential endogeneity, we use the percentage of Medicare beneficiaries enrolled in Medicare Advantage in each county-year as an instrument for individuals’ SNF length of stay among Traditional Medicare beneficiaries, as local Medicare Advantage penetration puts downward pressure on SNF length of stay for all SNF patients but does not directly affect utilization management of those enrolled in Traditional Medicare. We also test for heterogeneity in treatment effect across patients by clinical complexity and two non-health-related factors, marital status and nursing home profit status. We find that one additional day in a SNF lowers short-term readmission rates, but this effect is small and heterogeneous across patient-types. The most clinically complex patients (those with the longest predicted SNF stays) benefit the most from an additional SNF day, as do patients whose stays are shorter due to non-health-related factors. The cost savings from reduced readmission rates are small and do not offset the additional SNF costs.

Werner RM, Coe NB, Qi M, Konetzka T: The value of an additional day of post-acute care in a skilled nursing facility. American Journal of Health Economics 8(4), Jul 2022.

Racial and Ethnic Disparities in Dementia Care Next Steps

No abstract available

Coe NB, Lee C: Racial and Ethnic Disparities in Dementia Care: Next Steps (Invited Commentary, Geriatrics) JAMA Network Open 5(6): e2216267, Jun 2022.

Younger Individuals Increase Their Use of Nursing Homes Following ACA Medicaid Expansion

This study examines the effect of Medicaid eligibility expansion under the Affordable Care Act (ACA) on the utilization of nursing home services by younger individuals and those covered by Medicaid.

Ritter A, Freed S, Coe NB: Younger Individuals Increase Their Use of Nursing Homes Following ACA Medicaid Expansion. Journal of the American Medical Directors Association 23(5): 852-857, May 2022.

Out-of-pocket costs attributable to dementia: A longitudinal analysis

Alzheimer's disease and related dementias (ADRD) affect 5.7 million Americans, and are expensive despite the lack of a cure or even treatments effective in managing the disease. The literature thus far has tended to focus on the costs to Medicare, even though one of the main characteristics of ADRD (the loss of independence and ability to care for oneself) incurs costs not covered by Medicare. In this paper, we use survey data for 2002-2016 from the Health and Retirement Study to estimate the out-of-pocket costs of ADRD for the patient and their family through the first 8 years after the onset of symptoms, as defined by a standardized 27-point scale of cognitive ability. A two-part model developed by Basu and Manning (2010) allows us to separate the costs attributable to ADRD into two components, one driven by differences in longevity and one driven by differences in utilization.

Oney M, White L, Coe NB: Out-of-pocket costs attributable to dementia: A longitudinal analysis. Journal of the American Geriatrics Society (JAGS) 70(5): 1538-1545, May 2022.

Insurance coverage and health care spending by state-level Medigap regulations

Medigap protects traditional Medicare (TM) beneficiaries against catastrophic expenses. Federal regulations around Medigap enrollment and pricing are limited to the first 6 months after turning 65 years old. Eight states institute regulations that apply to later enrollment; half use community rating (charging everyone the same premium) and half use both community rating and guaranteed issue (requiring insurers to accept any beneficiary irrespective of health conditions). We examined the impact of state-level Medigap regulations on insurance coverage and health care spending for Medicare beneficiaries.

Park S, Coe NB: Insurance Coverage and Health Care spending by State-level Medigap Regulations. American Journal of Managed Care 28(4), Apr 2022.

Racial and ethnic disparities in access to and enrollment in high-quality Medicare Advantage plans

Racial and ethnic minority enrollees in Medicare Advantage (MA) plans tend to be in lower-quality plans, measured by a 5-star quality rating system. We examine whether differential access to high-rated plans was associated with this differential enrollment in high-rated plans by race and ethnicity among MA enrollees.

Park S, Werner RM, Coe NB: Racial and ethnic disparities in access to and enrollment in high-quality Medicare Advantage plans. Health Services Research Mar 2022 Notes: Online ahead of print.

Public spending on acute and long-term care for Alzheimer's disease and related dementias

We estimate the spending attributable to Alzheimer's disease and related dementias (ADRD) to the United States government for the first 5 years post-diagnosis.

Coe NB, White L, Oney M, Basu A, Larson EB: Public spending on acute and long-term care for Alzheimer's disease and related dementias. Alzheimer's & Dementia: the journal of the Alzheimer's Association Mar 2022 Notes: Online ahead of print.