UnitedHealthcare's specialized Medicare plan reduced ED visits for nursing home patients, study finds

When compared to fee-for-service Medicare beneficiaries, institutionalized UnitedHealthcare members with specialized Medicare Advantage coverage had lower emergency department use, according to a study published in The American Journal of Managed Care.

UnitedHealthcare's Medicare Advantage Institutional Special Needs Plans provide on-site, coordinated care for beneficiaries by linking them with advanced practice clinicians. For the study, researchers with the Department of Health Care Policy at Boston-based Harvard Medical School analyzed more than 8,000 members with UnitedHealthcare I-SNP and nearly 13,000 Medicare fee-for-service long-term nursing home residents in 13 states.

Rates of ED, inpatient and skilled nursing home facility use were compared between the two populations. The researchers found I-SNP members' ED use rate was 51 percent lower than the fee-for-service Medicare patients. In addition, I-SNP members had 38 percent fewer hospitalizations and 45 percent fewer readmissions. 

"'At-risk' models, administered through specialized Medicare Advantage plans, that invest in clinical management in the nursing home setting have the potential to allow individuals to receive care on-site and avoid costly inpatient transfers," the researchers concluded.

For the full study, click here.

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