MAOs Should Get Member Feedback, Rethink PA as Post-Acute Outcomes Decline

Medicare Advantage members using post-acute care services are reporting less favorable outcomes than their fee-for-service counterparts, according to a new study published in JAMA Health Forum. Not only are outcomes worse, MA beneficiaries are also using fewer post-acute care services than those enrolled in traditional Medicare (TM), which study authors said could be linked to payers’ tight prior authorization (PA) requirements.

The study authors explained that prior research on this topic, which has generally shown favorable post-acute outcomes in MA, relied largely on administrative data, which can’t capture individual beneficiaries’ perception of quality or health status. That’s why they looked to self-reported data from the National Health and Aging Trends Study, focusing on seniors age 70 and older who lived in community settings (rather than nursing homes). “Examining self-reported patient outcomes is key to ensuring that the MA program adequately meets beneficiaries’ needs, particularly since there is evidence that MA enrollees are treated at lower-quality SNFs [skilled nursing facilities],” authors wrote.

© 2024 MMIT
Carina Belles

Carina Belles

Carina is a reporter at AIS, specializing in public sector data research, trend analysis and infographics. She holds a Bachelor of Science in Journalism from Ohio University, joining AIS shortly after graduating in 2014.

Related Posts

policy-update
August 4

UnitedHealth Shares More Details About Prior Authorization Cutbacks

READ MORE
doctor-with-laptop-tablet
June 1

New PA Constraints May Not Satisfy Lawmakers’ Appetite for Industry Change

READ MORE
medicare-advantage
July 6

MedPAC Floats Benchmarking Options to Address Favorable Selection in MA

READ MORE

GAIN THERAPEUTIC AREA-SPECIFIC INTEL TO DRIVE ACCESS FOR YOUR BRAND

Sign up for publications to get unmatched business intelligence delivered to your inbox.

subscribe today