While Medicare Advantage (MA) penetration has skyrocketed, forcing home health providers to adapt their businesses. MA home health utilization, however, has dipped in recent years.
This is one key takeaway from a recent study from analytics and data science company Trilliant Health that found that, for certain demographics, home health utilization dipped as much as 63.1% over a five-year period.
Over the last 20 years, MA enrollment has grown significantly. MA, currently, represents more than half of all Medicare enrollment. It’s slated to increase to 64% by 2034, according to Trilliant researchers.
Despite this, numerous MA payers experienced unfavorable financial results in 2023. This was one of many factors that contributed to an unstable MA market in 2024. Raising cost-containment pressures and program changes also contributed to a volatile market that year.
MA plans cited higher-than-expected care utilization as the reason behind their poor financial performance in 2023.
In response, Trilliant Health decided to look into MA health care utilization trends, based on care settings, over several years. As part of the study, the company analyzed MA payer claims between 2018 and 2023. The analysis focused on patients who had at least three MA medical encounters and nine care settings, including home health. The company also focused on MA payers with large memberships such as Humana (NYSE: HUM), Centene Corp. (NYSE: CNC), Aetna, UnitedHealthcare and Anthem Inc. (NYSE: ANTM).
Overall, MA health care utilization went up by 19.9% across all care settings between 2018 and 2023, but it went down by 1.1% from 2022 to 2023.
“This increased utilization is not surprising given the 55.7% increase in MA enrollment over the period, suggesting some correlation between utilization growth and enrollment growth,” Trilliant Health wrote.
Looking specifically at home health, utilization decreased year-over-year from 2020 through 2023, dipping by 26.4% from 2022 to 2023.
When Trilliant Health looked at utilization, based on age, it found that between 2018 to 2023, home health use decreased by 36.5% for MA beneficiaries ages 65 to 79. Home health utilization also decreased by 63.1% for MA beneficiaries ages 80 and older during this same time period.
Trilliant Health also examined utilization based on payer. The company found that, compared to other major payers, Humana had the most home health utilization in 2023. Humana is one of the largest insurers in the country, and has almost six million MA members in its health plans. The company also has CenterWell — its provider services arm — which includes home health, pharmacy and primary care.
Ultimately, Trilliant Health researchers wrote that policymakers need to manage both cost containment and access to high-quality care. Moreover, researchers emphasized the need to address ongoing reductions in supplemental benefits and plan offerings.
“With projected spending growth outpacing that of Traditional Medicare, and amid heightened legislative scrutiny over risk adjustment and prior authorization practices, the finalized 5.06% increase in MA plan payments for 2026 presents both an opportunity and a challenge for the current Trump Administration,” researchers wrote. “Policymakers will need to balance the need for cost containment with ensuring continued access to high-quality care.”
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