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Differences in Home Health Services and Outcomes Between Traditional Medicare and Medicare Advantage
Rachel A. Prusynski, Anthony D’Alonzo, Michael P. Johnson, Tracy M. Mroz, Natalie E. Leland. JAMA Health Forum, 2024-03-01
Topic: Risk, prevention and care in population studies
Of 285 297 total patients, 180 283 (63.2%) were female; 586 (0.2%) were American Indian/Alaska Native, 8957 (3.1%) Asian, 28 694 (10.1%) Black, 7406 (2.6%) Hispanic, 1959 (0.7%) Native Hawaiian/Pacific Islander, 237 017 (83.1%) non-Hispanic White, and 678 (0.2%) multiracial individuals. MA patients had shorter home health length of stay by 1.62 days (95% CI, -1.82 to 1.42) and received fewer visits from all disciplines except social work. There were no differences in inpatient transfers. MA patients had 3% and 4% lower adjusted odds of improving in mobility and self-care, respectively (mobility odds ratio [OR], 0.97; 95% CI, 0.94-0.99; self-care OR, 0.96; 95% CI, 0.92-0.99). MA patients were 5% more likely to discharge to the community compared with TM (OR, 1.05; 95% CI, 1.01-1.08). Conclusions and Relevance: The results of this cross-sectional study suggest that MA patients receive shorter and less intensive home health care vs TM patients with similar needs. Differences may be due to the administrative burden and cost-limiting incentives of MA plans. MA patients experienced slightly worse functional outcomes but were more likely to discharge to the community, which may have negative implications for MA patients, including reduced functional independence or increased caregiver burden.
Key findings
- Of 285 297 total patients, 180 283 (63.2%) were female; 586 (0.2%) were American Indian/Alaska Native, 8957 (3.1%) Asian, 28 694 (10.1%) Black, 7406 (2.6%) Hispanic, 1959 (0.7%) Native Hawaiian/Pacific Islander, 237 017 (83.1%) non-Hispanic White, and 678 (0.2%) multiracial individuals.
- MA patients had shorter home health length of stay by 1.62 days (95% CI, -1.82 to 1.42) and received fewer visits from all disciplines except social work.
- There were no differences in inpatient transfers.
- MA patients had 3% and 4% lower adjusted odds of improving in mobility and self-care, respectively (mobility odds ratio [OR], 0.97; 95% CI, 0.94-0.99; self-care OR, 0.96; 95% CI, 0.92-0.99).
- MA patients were 5% more likely to discharge to the community compared with TM (OR, 1.05; 95% CI, 1.01-1.08).
Why it matters
This study found that Medicare Advantage patients received shorter and less intensive home health care than traditional Medicare patients with similar needs, and had slightly worse functional outcomes but were more likely to discharge to the community. The authors suggest this may have negative implications such as reduced functional independence or increased caregiver burden.
Study details
- Study designcross-sectional
- Participants178
- Effect size63.2%; 0.2%; 3.1%
- Evidence strengthLow
How this study scored 57/100
Published in a peer-reviewed journal, and it is a snapshot of people at one point in time. Scored zero for randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (JAMA Health Forum) |
| Journal's citation record | 0 / 4 | JAMA Health Forum: journal h-index 60 (OpenAlex, 2026-10-29) |
| Study design | 4 / 12 | A snapshot of people at one point in time |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2024 — within 3 year(s) of the newest study here |
| Sample size | 2 / 4 | 178 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 4 / 7 | Cited 41 times (OpenAlex, 2026-10-10) |
| Citations per year | 3 / 5 | 10.2 citations a year over 4 year(s) since 2024 |
| Impact for its field and year | 4 / 6 | Cited 14.8× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 1 / 6 | Cited by 2 other studies in this library |
| Still being cited | 2 / 4 | Cited 41 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author Natalie E. Leland: h-index 23 (OpenAlex, whole career) |
| Institution's track record | 3 / 3 | University of Washington: institution h-index 3,540 (OpenAlex) |
| Multi-centre collaboration | 1 / 3 | OpenAlex lists 2 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 38427341) |
| Free to read | 2 / 2 | Free to read |
| Total | 57 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
- DOI: 10.1001/jamahealthforum.2023.5454
- PubMed: 38427341
- Original source →
- Free full text: JAMA Health Forum →
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Prusynski, R. A., D’Alonzo, A., Johnson, M. P., Mroz, T. M., & Leland, N. E. (2024). Differences in Home Health Services and Outcomes Between Traditional Medicare and Medicare Advantage. JAMA Health Forum. https://doi.org/10.1001/jamahealthforum.2023.5454
Vancouver
Prusynski RA, D’Alonzo A, Johnson MP, Mroz TM, Leland NE. Differences in Home Health Services and Outcomes Between Traditional Medicare and Medicare Advantage. JAMA Health Forum. 2024. doi:10.1001/jamahealthforum.2023.5454. PMID: 38427341.
BibTeX
@article{prusynski2024-38427341,
author = {Prusynski, Rachel A. and D’Alonzo, Anthony and Johnson, Michael P. and Mroz, Tracy M. and Leland, Natalie E.},
title = {{Differences in Home Health Services and Outcomes Between Traditional Medicare and Medicare Advantage}},
journal = {JAMA Health Forum},
year = {2024},
doi = {10.1001/jamahealthforum.2023.5454},
pmid = {38427341},
url = {https://doi.org/10.1001/jamahealthforum.2023.5454}
}
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