Medicare Advantage documents

Members of Medicare Advantage plans used post-acute care less than people with traditional Medicare, according to an analysis of 62 studies on beneficiaries’ experiences with affordability, utilization and quality of both plans.

Overall, the investigation could not determine whether beneficiaries’ lower post-acute care use was associated with better or worse outcomes. The review included studies conducted since 2016.

One of the categories that showed some difference between the plans was utilization for post-acute needs, Jeannie Fuglesten Biniak, co-author of the Kaiser Family Foundation analysis titled Beneficiary Experience, Affordability, Utilization, and Quality in Medicare Advantage and Traditional Medicare: A Review of the Literature, told McKnight’s Long-Term Care News.

“It does look like utilization is lower among people who are in Medicare Advantage plans than those who are in traditional Medicare plans,” she said.

There are two theories that could explain the lower usage, said Fuglesten Biniak. One was the existence of prior authorization requests in Medicare Advantage plans.

“One of the areas they found prior authorization denials being used is in the post-acute care space,” said Fuglesten Biniak. “Traditional Medicare has no prior authorization or precertification requirement. Medicare Advantage plans can impose those, and this is one area it seems like they do.”

For her second theory, she admits there is less evidence.

“(Medicare Advantage plans) do a better job of keeping people healthier before they go into the hospital or in figuring out the type of care they need upon discharge and are able to avoid the use of facilities,” she said. “So we also see lower use of home health, too, among Medicare Advantage (enrollees).”

Overall, the analysis found that beneficiaries in both Medicare Advantage and traditional Medicare reported similar rates of satisfaction with their care, experiences with wait times, finding a new provider and overall measures of care coordination. 

Studies examining outcome measures for users of skilled nursing facilities found lower hospital readmission rates among Medicare advantage enrollees, but findings were inconsistent on other outcome measures.

Enrollees in Medicare Advantage plans were more likely to report having a usual source of care and receiving preventive services such as annual wellness visits and the flu vaccine. Medicare Advantage enrollees had lower hospital readmission rates, but they were less likely than traditional Medicare beneficiaries to receive care in hospitals, skilled nursing facilities, and home health agencies with the highest quality ratings.”

Other notes of interest to SNF operators:

* Two studies found Medicare Advantage enrollees were less likely to receive care from the highest-quality skilled nursing facilities and home health agencies;

* Six studies generally found that Medicare Advantage enrollees were less likely than traditional Medicare beneficiaries to receive care from the highest or lowest rated hospitals overall.