Long-term nursing home residents enrolled in UnitedHealthcare’s Medicare Advantage Institutional Special Needs Plans (I-SNPs) are 112% more likely to use skilled nursing services than those with Medicare fee-for-service plans, a new study found.
Researchers also found that Medicare Advantage I-SNP members had 51% lower emergency department use, 38% fewer hospital admissions and 45% fewer readmissions than Medicare fee-for-service beneficiaries.
“A major focus in long-term care policy has been to improve access to on-site clinical care in order to rebalance medical care utilization away from the ED and inpatient settings. By providing on-site advanced practice clinicians and making the insurer financially responsible for care in and out of the nursing home, the I-SNP model tested here was shown to have lower ED and inpatient utilization and higher SNF utilization relative to FFS Medicare,” Harvard researchers Brian McGarry, Ph.D., and David Grabowski, Ph.D., concluded.
“Our results suggest that this I-SNP model is one potential approach to shift care to less costly clinical settings and can help inform the development and implementation of other value-based payment models in the SNF population.”
Researchers examined data from 2014 and 2015 for more than 8,000 I-SNP members at nursing homes throughout 13 states. They also examined data of nearly 13,000 Medicare fee-for-service beneficiaries for the study.
Findings were published Thursday in the American Journal of Managed Care.