How Home-Based Medical Care Is Utilized In Traditional Medicare, Medicare Advantage

There are significant differences in home-based medical care utilization between Medicare Advantage (MA) and traditional Medicare beneficiaries.

Specifically, having exactly one home-based medical care visit was 31 times as likely for MA beneficiaries, at 18.6%, compared to traditional Medicare beneficiaries at 0.6%.

That’s likely, in part, due to incentives in the MA program to code all accurate diagnoses, according to a new study published in Health Affairs this month.


When it comes to multiple home-based medical care visits, it’s a different story. While 2.1% of traditional Medicare beneficiaries receive multiple visits, only 1.6% of MA beneficiaries do.

One visit for a beneficiary may just mean an in-home assessment, which is an increasingly popular way for MA plans and other home-based care companies to screen patients in their homes for needs and health concerns.

CVS Health’s (NYSE: CVS) Signify Health and UnitedHealth Group’s Optum, for instance, are two of the leaders of in-home assessments.


“It does, in fact, support those relationships and helps drive patients to primary care,” Denise Graeber, senior vice president of product management at Signify Health, recently said during a webinar. “When we think about in-home evaluations, they have historically been targeted at Medicare Advantage members. The need and the value of in-home evaluations is continuing to grow.”

Multiple visits means more longitudinal care, where a physician or other care professional is visiting a beneficiary’s home multiple times throughout the course of the year. That kind of care is also becoming increasingly popular, as it reduces barriers for senior patients and others who are homebound.

“Those are really the two types of visits that we’re going to distinguish from each other,” Jeffrey Marr, a PhD candidate at Johns Hopkins and one of the study’s authors, said during a Health Affairs podcast appearance. “Our headline finding is that in Medicare Advantage, the rates of longitudinal care use are somewhat lower than in traditional Medicare. But the rates of one-time visits – likely for assessment purposes – are substantially higher in Medicare Advantage.”

The study looked at home-based medical care data from 2018.

A broad range of patients are receiving these one-time assessments in MA, while older seniors with multiple limiting conditions are more likely to receive longitudinal home-based medical care, Marr said.

“We looked at various measures – age, different measures of hospitalizations and chronic conditions,” he said. “And we find that across all of those, the patients who get the longitudinal care are older, they are more likely to be hospitalized, they have more chronic conditions, they are more likely to have Alzheimer’s and dementia. What we really think is that these are very distinct types of services serving two very different types of groups within MA.”

A lot of it goes back to MA plan incentives.

At the same time, the data also shows that it may be beneficial for traditional Medicare beneficiaries to gain further access to both one-time and longitudinal home-based medical care.

“I think from the patient’s perspective, there’s a lot of upside,” Marr said. “It’s an additional visit with a provider in their home. And that can be helpful in terms of screening for things like fall risk or just seeing what’s going on in their home. [It’s also] helpful for connecting them to other resources that are available.”

Those other resources could include other care providers. That’s one of the reasons why in-home primary care, for instance, could be a tailwind for all sorts of home-based care agencies.

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