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Medicare Advantage Control of Postacute Costs: Perspectives From Stakeholders
Brown Univ, Sch Publ Hlth, Ctr Gerontol & Healthcare Res, Providence, RI 02903 USA.
RTI Int, Waltham, MA USA.
Brown Univ, Sch Publ Hlth, Ctr Gerontol & Healthcare Res, Providence, RI 02903 USA.
Columbia Univ, Mailman Sch Publ Hlth, New York, NY USA.
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2018 (English)In: American Journal of Managed Care, ISSN 1088-0224, E-ISSN 1936-2692, Vol. 24, no 12, p. E386-E392Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Medicare Advantage (MA) plans have strong incentives to control costs, including postacute spending; however, to our knowledge, no research has examined the methods that MA plans use to control or reduce postacute costs. This study aimed to understand such MA plan efforts and the possible unintended consequences. STUDY DESIGN: A multiple case study method was used. METHODS: We conducted 154 interviews with administrative and clinical staff working in 10 MA plans, 16 hospitals, and 25 skilled nursing facilities (SNFs) in 8 geographically diverse markets across the United States. RESULTS: Participants discussed how MA plans attempted to reduce postacute care spending by controlling the SNF to which patients are discharged and SNF length of stay (LOS). Plans typically influenced SNF selection by providing patients with a list of facilities in which their care would be covered. To influence LOS, MA plans most commonly authorized patient stays in SNFs for a certain number of days and required that SNFs adhere to this limitation, but they did not provide guidance or assistance in ensuring that the LOS goals were met. Hospital and SNF responses to the largely authorization-based system were frequently negative, and participants expressed concerns about potential unintended consequences. CONCLUSIONS: In their interactions with hospitals and SNFs, MA plans attempted to influence the choice of SNF and LOS to control postacute spending. However, exerting too much influence over hospitals and SNFs, as these results seem to indicate, may have the negative consequences of delayed hospital discharge and SNFs' avoidance of burdensome plans.

Place, publisher, year, edition, pages
2018. Vol. 24, no 12, p. E386-E392
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
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URN: urn:nbn:se:uu:diva-374123ISI: 000454860000004PubMedID: 30586487OAI: oai:DiVA.org:uu-374123DiVA, id: diva2:1281978
Available from: 2019-01-23 Created: 2019-01-23 Last updated: 2019-01-23Bibliographically approved

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Winblad, Ulrika

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