The Chronically Critically Ill: Access to Care, Treatment Patterns, and Outcomes in Medicare Advantage

With the growth of Medicare Advantage (MA), increasing attention has focused on comparing how quality and access to care for Medicare beneficiaries differ between MA and Traditional Medicare (TM). However, limited evidence exists on the impact of enrollment in MA among severely ill patients, such as those with chronic critical illnesses.  In this study, we assess the evidence related to the effects of enrollment in MA on the chronically critically ill (CCI) (and other populations of severely ill Medicare beneficiaries), as well as access to long-term acute care hospitals (LTCHs) under MA.  We also examine the literature comparing quality, outcomes, and patterns of inpatient care for CCI patients in MA and TM.

We found no studies that examined the extent to which the CCI population enroll in MA or switch out of MA. However, Medicare beneficiaries enrolled in MA who had high utilization of healthcare services were more likely to switch from MA to TM.  MA beneficiaries were likely to stay longer at the short-term acute care hospital (STACH) than TM beneficiaries. For CCI patients, patients with severe wounds, and ventilator populations, MA enrollees were less likely to be discharged to an LTCH than TM. The overall use rate for LTCHs was 1% for TM and 0.6% for MA. For the severe wound population, the rates of LTCH use for TM and MA beneficiaries were 7.9% and 5.6%, respectively. The rate of LTCH use for the ventilator population was 24.1% for TM beneficiaries and 18.5% for MA beneficiaries. Finally, we found few studies that compared outcomes between TM and MA for a CCI or other high severity populations.

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