title: Does Medicare Advantage enrollment affect home healthcare use?
abstract: OBJECTIVE
  To compare home health utilization and clinical outcomes between Medicare beneficiaries in the fee-for-service (FFS) and Medicare Advantage (MA) programs, and to compare regional variation.
  
  
  METHODS
  We used the 2010 and 2011 Outcome and Assessment Information Set to identify all home health episodes begun in 2010 and to measure 7 clinical home health outcomes that are defined by CMS for public reporting.
  
  
  METHODS
  We modeled the probability of home health use, the duration of home health episodes, and each clinical outcome measure as a function of MA versus FFS enrollment and model-specific risk adjustors. Empirical Bayes predictions from generalized linear mixed models were aggregated by hospital referral region (HRR) to create standardized regional measures of home health utilization and mean episode duration.
  
  
  RESULTS
  We identified 30,837,130 FFS and 10,594,658 MA beneficiaries (excluding those dually eligible for Medicaid). After adjusting for demographic and clinical patient characteristics, the odds of receiving home health among FFS enrollees were 1.83 times those of MA (95% CI, 1.82-1.84). Adjusted home health duration was 34% longer for FFS (95% CI, 32%-34%). Outcomes differences were small in magnitude and inconsistent across measures. Regional variations in use and duration were substantial for both FFS and MA enrollees. Within HRRs, correlations between FFS and MA utilization rates and between FFS and MA episode durations were 0.51 and 0.94, respectively.
  
  
  CONCLUSIONS
  MA beneficiaries use less home health than their FFS counterparts, but regional factors affect utilization, independent of insurance status.
authors.affiliation: RAND Corporation, 1776 Main St, Santa Monica, CA 90407. E-mail: dwaxman@rand.org.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Waxman
authors.forename: Lillian
authors.initials: L
authors.lastname: Min
authors.forename: Claude M
authors.initials: CM
authors.lastname: Setodji
authors.forename: Mark
authors.initials: M
authors.lastname: Hanson
authors.forename: Neil S
authors.initials: NS
authors.lastname: Wenger
authors.forename: David A
authors.initials: DA
authors.lastname: Ganz
mesh_terms: D000368:Aged; D018588:Fee-for-Service Plans / Q000191:economics; D005260:Female; D006279:Health Maintenance Organizations / Q000191:economics / Q000706:statistics & numerical data; D006699:Home Care Services / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008484:Medicaid / Q000191:economics* / Q000706:statistics & numerical data; D020398:Medicare Part C / Q000191:economics* / Q000706:statistics & numerical data; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D019984:Quality Indicators, Health Care; D020379:Risk Adjustment; D014481:United States