For over 25 years, Medicare policy has promoted beneficiaries'enrollment in private, risk-bearing plans, currently known as Medicare Advantage (MA) plans. The 2006 Medicare Modernization Act (MMA) increased MA payments and compensated plans for serving more medically complex and frail beneficiaries, stimulating a doubling of the MA population over the past 8 years. This explosive growth in MA enrollment has also occurred among nursing home residents;however, we know virtually nothing about the quality and outcomes of care among nursing home residents in private, managed care plans. This lack of knowledge compromises our ability to understand the implications of expansions of special needs and dual eligible MA plans included in the Affordable Care Act (ACA). Because the Medicare program spends $115 billion in annual capitated payments to MA plans, understanding their emerging role in caring for frail, chronically ill beneficiaries is critical to inform optimal federal policy. Between 2000 and 2010 the prevalent population of MA plan members in nursing homes increased from about 16,000 to 80,000 (about 8% of all long stay residents). Half of these individuals reside in only 500 nursing facilities, each with more than 75 MA plan members. United Healthcare's """"""""Evercare"""""""" program, which provides integrated medical care and care management services to MA plan beneficiaries residing in nursing homes, was associated with lower mortality, fewer preventable hospitalizations, and cost- savings of approximately $100,000 per year per nurse practitioner. Of note, Evercare was initiated before the MMA and the subsequent growth of MA plans'use of nursing homes for post-acute and long term care patients. The long-term objective of this research is to inform policy efforts to improv the quality and outcomes of care for vulnerable nursing home residents. The objective of this application, which is the next step in our long-range goal, is to examine the impact of Medicare Advantage plans on the care of nursing home residents, both among residents enrolled in these plans as well as on non-MA residents via """"""""spill-over"""""""" effects. The rationale that underlies this investigation is that MA plans have assumed a rapidly growing role in the care of nursing home residents with little knowledge about how managed care may impact this frail, chronically-ill population. Our central hypothesis, which is informed by the results of the Evercare evaluation and the paucity of other studies, is that integrated medical cares in the nursing home setting, particularly in facilities where MA plan residents are concentrated, positively affect patient outcomes. We propose to undertake a comprehensive examination of the growth of these plans and their impact on nursing home care using 15 years (2000 through 2014) of data on MA plans'use of nursing facilities that integrates Medicare enrollment records, HEDIS data reported to CMS, and the mandatory nursing home resident assessment minimum data set (MDS).

Public Health Relevance

Despite the dramatic increase in the population of nursing home residents enrolled in Medicare Advantage plans, there is virtually no evidence to guide policymakers about the quality and outcomes of care for this frail, chronically-ill population. Using 15 years of data, we will examine the impact of the emerging role of Medicare Advantage plans in caring for nursing home residents.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project (R01)
Project #
1R01AG047180-01
Application #
8673221
Study Section
Special Emphasis Panel (ZRG1)
Program Officer
Bhattacharyya, Partha
Project Start
2014-07-01
Project End
2017-04-30
Budget Start
2014-07-01
Budget End
2015-04-30
Support Year
1
Fiscal Year
2014
Total Cost
Indirect Cost
Name
Brown University
Department
Public Health & Prev Medicine
Type
Schools of Public Health
DUNS #
City
Providence
State
RI
Country
United States
Zip Code
02912
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Goldberg, Elizabeth M; Keohane, Laura M; Mor, Vincent et al. (2018) Preferred Provider Relationships Between Medicare Advantage Plans and Skilled Nursing Facilities Reduce Switching Out of Plans: An Observational Analysis. Inquiry 55:46958018797412
Kumar, Amit; Rahman, Momotazur; Trivedi, Amal N et al. (2018) Comparing post-acute rehabilitation use, length of stay, and outcomes experienced by Medicare fee-for-service and Medicare Advantage beneficiaries with hip fracture in the United States: A secondary analysis of administrative data. PLoS Med 15:e1002592
Jung, Hye-Young; Li, Qijuan; Rahman, Momotazur et al. (2018) Medicare Advantage enrollees' use of nursing homes: trends and nursing home characteristics. Am J Manag Care 24:e249-e256
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Goldberg, Elizabeth M; Trivedi, Amal N; Mor, Vincent et al. (2017) Favorable Risk Selection in Medicare Advantage: Trends in Mortality and Plan Exits Among Nursing Home Beneficiaries. Med Care Res Rev 74:736-749
Rahman, Momotazur; Keohane, Laura; Trivedi, Amal N et al. (2015) High-Cost Patients Had Substantial Rates Of Leaving Medicare Advantage And Joining Traditional Medicare. Health Aff (Millwood) 34:1675-81