Unfulfilled home health referrals lead to higher mortality among Medicare Advantage (MA) members, according to a report published in the American Journal of Managed Care (AJMC).
Key takeaways from the report:
Following acute hospitalization, MA members with orders to receive home health may not ultimately receive these services for member- or healthcare system–related reasons. Common reasons for unfulfilled home health referrals include member refusal of service and an inability to contact or locate the member.
Poor Access Leads to Poor Outcomes
Among those with discharge orders to receive home health, those who did not receive service experienced significantly higher mortality at 30, 90, and 180 days post-discharge.
Because referring hospital physicians believe that their members will receive home health and may plan their discharges accordingly, the report encourages care teams to address gaps in understanding, anticipate barriers to service, and strengthen communication between inpatient teams and home health agencies.
The number of Medicare beneficiaries is projected to grow to more than 80 million by 2030, up from 54 million in 2015. Meanwhile, the percentage of total Medicare beneficiaries enrolled in a MA plan increased steadily from 19% in 2007 to 51% in 2023. To deliver high-quality member-centered care while controlling costs, MA plans need to optimize treatment of their members in the home setting, according to the report.
To deliver high-quality member-centered care while controlling costs, MA plans need to optimize treatment of their members in the home setting.
There may be a role for home health during the post-hospital period to provide continuity of care in the home. But not every member who is referred to home health ultimately receives home health services for a variety of reasons.
The study underscores the importance of clear guidance for clinicians on home health referral criteria, improved member education of home health services, improved assessment of social determinants of health, and improved care coordination and transparency.
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