Home health agencies (HHAs) are an important source for skilled nursing care, with 3.1 million traditional Medicare beneficiaries receiving such services in 2020. Two potentially important advantages of home health are: (1) patient preference for recovery at home; and (2) lower costs to beneficiaries, since there is no cost sharing for home health in Medicare. However, studies have documented lower access to high-quality HHAs for Black beneficiaries, with resulting disparities in outcomes. In a recent study, Fashaw-Walters and colleagues reported that access to high-quality HHA services was “out of reach” for Black Medicare beneficiaries and other vulnerable populations. This finding is at odds with our own research, published in a recent Commonwealth Fund Issue Brief, where we found no significant difference in access to high-quality HHAs between White and Black beneficiaries. To better understand these divergent findings and implications, we examine differences in the research designs of the two studies and then explore how these differences can lead to different conclusions.
Studies Differ in Terms of Research Design
|
Marie Steele-Adjognon is a Senior Research Associate in the Evaluation and Health Economics Practice at KNG Health. She has formal training and experience in conducting quasi-experimental analyses, simulation models, demand projections, econometric analysis of both cross-sectional and panel data, and instrumental variable techniques. Dr. Steele-Adjognon conducts episode-based analysis, following patients’ episodes of care starting from admission to the short-term acute care hospital to the post-acute care (PAC) setting and then for a period of time following the post-acute care treatment. Common health outcomes she evaluates are mortality rates, readmission rates, and total healthcare spending. Examples of her work include evaluating how well different risk adjustment methods are able to capture variations in health outcomes; monitoring health outcomes, as well as PAC utilization, over time as different policies and programs change; simulating how new potential health care policy ideas might affect the number of people insured and how they are insured (through employer, public resources, etc.); and evaluating how individual hospitals compare to others in terms of market share and health outcomes within their geographic proximity using Medicare claims files. One specific project she is working on is evaluating how Maryland’s unique SIM All Payer system affects discharge rates, length of stay and Medicare and Medicaid charges at short term acute hospitals in addition to post-acute care settings throughout Maryland for the dual eligible population. Dr. Steele-Adjognon earned her BS in Mathematics and Financial Economics from University of Maryland Baltimore County and her PhD in Agricultural, Food and Resource Economics from Michigan State University. |
|
Inna Cintina is a Principal Research Associate in the Evaluation and Health Economics Practice. Dr. Cintina is an applied microeconomist with over a decade of research experience in the area of health economics. Prior to joining KNG Health, Dr. Cintina worked at the Lewin Group/OptumServe and the University of Hawaii at Manoa. Inna has extensive experience in developing and implementing methodologies for identification of causal relationships, advanced analytics, project management, economic burden/cost of illness studies, and impact evaluations of alternative payment models, such as CMMI’s Bundled Payments for Care Improvement Initiative and Oncology Care Model. She is an expert in using matching techniques, difference-in-difference methodologies, and other quasi-experimental statistical approaches, as well as producing client-oriented materials, white papers, and manuscripts. She has authored/co-authored more than a dozen articles, which have been published in peer-reviewed journals including, but not limited to, World Bank Economic Review, Contemporary Economic Policy, Health Economics, and JAMA. Dr. Cintina has a PhD in economics from Clemson University, a MSC in European Economics and Public Affairs from University College Dublin, and an MA and a BA in economics from the University of Latvia. |
|
Lane Koenig is President and Founder of KNG Health Consulting and Director of the Healthcare Reform and Payment Innovation Practice. He is a healthcare economist with over 20 years’ experience in the public and private sectors. As President of KNG Health Consulting, Dr. Koenig has overall responsibility for the quality and direction of KNG Health’s research. He serves as Project Director and Principal Investigator for many studies, particularly those related to healthcare reform proposals, healthcare provider payments, value-based purchasing, and delivery system innovations. With expertise on hospital and post-acute care payment and quality issues, his work regularly assesses the potential impact on hospitals and other providers of proposed legislation or regulations. He has assisted both industry and Federal and state governments in the development and assessment of healthcare provider payment policies and value-base purchasing initiatives. Prior to founding KNG Health in 2007, Dr. Koenig was the senior economist in the Office of Policy at the Centers for Medicare & Medicaid Services (CMS). Before joining CMS, Dr. Koenig was a Senior Scientist in the healthcare finance practice at The Lewin Group. Dr. Koenig has led over 100 quantitative and qualitative health policy and health economic studies and has published over 20 peer-reviewed studies in journals, such as Health Affairs, Health Services Research, and Medical Care. He graduated with Honors from the University of Florida, Gainesville and earned his PhD in Economics from the University of Maryland, College Park. |