Nurse in blue scrubs checks older woman's heart with stethoscope

A recent large-scale study revealed less home health use among Medicare Advantage beneficiaries compared with traditional Medicare recipients. And the reasons why could include MA plans’ lack of understanding of home health as well as a burdensome pre-authorization process that restricts access to skilled home health.

During a recent National Association for Home Care & Hospice webinar, Elizabeth Hamlett, a senior research associate at KNG Health Consulting LLC, and Jennifer Schiller, executive director of the Alliance for Home Health Quality and Innovation, honed in on the key conclusions of the May 2021 report. KNG Health, which the Alliance contracted with for the study, conducted a scoping literature review consisting of 27 research projects.

“Prior literature suggests that utilization of home health is lower in MA relative to traditional Medicare,” Hamlett said.

Even when physicians prescribe home health, MA beneficiaries are less likely to receive that care, she explained. Also, even when home healthcare is deemed medically necessary, MA enrollees find it less accessible and have less access to home health agencies in particular. And MA plans control home health more tightly than traditional Medicare plans, managing networks through pre-authorization and referral requirements.

Knowledge gap

This study is not the only evidence of this differing utilization of home health. Data firm Trella Health also has talked about this issue as well.

A dearth of knowledge of home health may be contributing to the problem. As part of the KNG Health Consulting study, researchers interviewed two home health executives and two home health physician-researchers to gather information on the use and value of home health in MA. One interview said MA plans aren’t aware of the skilled nursing care provided and associate home health with community-based care. This same lack of understanding is present among MA beneficiaries, the interviewee suggested.

Another stumbling block is MA plans’ restrictive authorization process. It is onerous, places added burden on the provider and may be limiting access to skilled home health services, providers said. Eligibility criteria also may be curtailing access. These restrictions actually may stem from a lack of understanding about the value home health offers to the beneficiary and overall health system, interviewees said.

Need to demonstrate value

One takeaway of the study is the need to demonstrate the value of home health to MA and other stakeholders. Demonstrating this value involves addressing care quality and cost associated with home health, Hamlett said.

Another takeaway is the upcoming opportunities for home health innovations. The supplemental benefits that MA now can offer could have an impact on the home health industry. Alternative payment models also present a chance for home health providers to innovate and expand their services and care delivery, according to Hamlett.