A study in JAMA Health Forum suggests Medicare Advantage (MA) plans should gather patient feedback to shape post-acute care policies. Vanderbilt University Medical Center researchers found that despite using fewer post-acute care services, MA beneficiaries reported less favorable outcomes than traditional Medicare enrollees. This insight is crucial as MA expands and health insurers aim to optimize post-acute care utilization. The study emphasizes the importance of patient-reported outcomes and addressing care satisfaction gaps.
A recent study published in JAMA Health Forum suggests that Medicare Advantage (MA) plans should integrate patient feedback to shape their post-acute care policies. The study, conducted by Vanderbilt University Medical Center researchers, reveals that gathering input from beneficiaries about the effectiveness of post-acute care in aiding their recovery after hospitalization is crucial.
According to the findings, recipients of Medicare Advantage experienced a lower utilization of post-acute care services compared to those enrolled in traditional Medicare. Despite this, the MA beneficiaries reported less favorable outcomes. This aspect warrants attention from policymakers, especially given the continued expansion of the MA program. Health insurers operating MA plans might perceive the use of post-acute care services as inefficient, prompting potential cutbacks.
In 2020, fee-for-service Medicare expended approximately $57 billion on post-acute care services. The study’s corresponding author, Emma Achola, emphasized that the research underscores potential gaps in care satisfaction within Medicare Advantage plans. These gaps must be addressed to ensure that patients receive appropriate and timely care.
Previous research indicated that MA beneficiaries were more likely to experience successful discharges to their communities and have extended community stays after discharge compared to those with traditional Medicare. Although there was no notable difference in mortality rates between MA and Medicare beneficiaries, the former group exhibited a reduced likelihood of hospital readmissions.
However, the researchers highlighted a limitation of past studies: their reliance solely on administrative data, neglecting self-reported patient perspectives. The study stresses the significance of assessing self-reported patient outcomes, especially considering evidence suggesting that MA enrollees might receive lower-quality care at skilled nursing facilities.
To gather comprehensive data, the research team used information from the National Health and Aging Trends Study, which included self-reported post-acute care utilization and outcomes. Conducted between 2015 and 2017 through interviews with individuals aged 70 and older living in communities (not nursing homes), the study aimed to minimize underlying disparities between MA and traditional Medicare populations.
The study revealed that MA achieved savings through the evaluation of administrative data within the Medicare Shared Savings Program, as well as mandatory bundled payments that reduced post-acute care usage without adverse effects. The researchers underscored the importance of MA plans soliciting feedback directly from patients to evaluate potential drops in satisfaction scores.
Moreover, the study suggested that differences in perceived improvement could be tied to MA utilization management practices. Requiring prior authorization for post-acute services might lead to delays in treatment or even premature termination of services before patients are adequately prepared.
Emma Achola clarified that by “self-reported,” the study refers to patients being directly asked about their perceptions of functional improvement and goal attainment. Patients possess the ability to gauge how the care they received influenced their well-being, making their responses to such inquiries valuable. The inclusion of patient-reported outcomes can offer policymakers insights into aspects of care that claims and administrative data fail to capture, underscoring their role in assessing care quality.
