UnitedHealthcare® ISNP members: 38% fewer admits
than FFS
Harvard Medical School researchers study ISNP1
New study finds that on-site clinical model is associated with
lower emergency department (ED) and inpatient utilization among nursing home
residents
A new
study by Harvard Medical School researchers found that members of
UnitedHealthcare Medicare Advantage Institutional Special Needs Plans (ISNP)
using the Optum care model had lower rates of ED, inpatient use and hospital
readmissions compared with traditional Medicare fee-for-service (FFS) nursing
home residents.
The
American Journal of Managed Care, the leading peer-reviewed journal dedicated
to managed care trends, published the study.
Comparing
two groups
Two groups were compared to assess whether investing in clinical management in nursing home settings has the potential to enable residents to receive care onsite and avoid transfers to other, more costly settings. One group consisted of long-term nursing home residents who are members in a UnitedHealthcare ISNP plan. The other group was nursing home residents covered by fee-for-service Medicare. Both groups had spent one year in long-term care.
Two groups were compared to assess whether investing in clinical management in nursing home settings has the potential to enable residents to receive care onsite and avoid transfers to other, more costly settings. One group consisted of long-term nursing home residents who are members in a UnitedHealthcare ISNP plan. The other group was nursing home residents covered by fee-for-service Medicare. Both groups had spent one year in long-term care.
The
findings
The researchers found significant differences in utilization between the two groups, even after adjusting for demographic differences. Compared with the FFS Medicare group, ISNP members had 38% fewer hospitalizations, 51% lower ED use and 45% fewer readmissions, while the rate of SNF use was 112% higher.
The researchers found significant differences in utilization between the two groups, even after adjusting for demographic differences. Compared with the FFS Medicare group, ISNP members had 38% fewer hospitalizations, 51% lower ED use and 45% fewer readmissions, while the rate of SNF use was 112% higher.
Potential
$1 billion spending difference
According to the researchers, the results illustrate the potential relationship between clinical care investment in the nursing home and decreased institutional use outside the facility. The study results suggest that if traditional Medicare beneficiaries exhibited similar utilization patterns in inpatient, ED and SNF use to the ISNP beneficiaries, use of a care model such as the Optum model for UnitedHealthcare ISNP members could result in roughly $1.6 billion decrease in spending on these services annually (not including the costs of the care model).
According to the researchers, the results illustrate the potential relationship between clinical care investment in the nursing home and decreased institutional use outside the facility. The study results suggest that if traditional Medicare beneficiaries exhibited similar utilization patterns in inpatient, ED and SNF use to the ISNP beneficiaries, use of a care model such as the Optum model for UnitedHealthcare ISNP members could result in roughly $1.6 billion decrease in spending on these services annually (not including the costs of the care model).
Study
structure
The researchers examined data from UnitedHealthcare ISNPs, offered in multiple states. These plans partner with Optum, a leading health-services company, to include an added layer of clinical care to plan members residing long-term in a nursing home. Optum provides enhanced care through advanced practice clinicians (APCs) — nurse practitioners or physician assistants. APCs coordinate and deliver care in conjunction with the facility staff, primary care physicians and other providers.
The researchers examined data from UnitedHealthcare ISNPs, offered in multiple states. These plans partner with Optum, a leading health-services company, to include an added layer of clinical care to plan members residing long-term in a nursing home. Optum provides enhanced care through advanced practice clinicians (APCs) — nurse practitioners or physician assistants. APCs coordinate and deliver care in conjunction with the facility staff, primary care physicians and other providers.
Significance
Nursing home resources are stretched thin in the effort to keep up with the needs of their populations. The nursing shortage, for example, is a major challenge. According to new payroll-based data, nursing home staffing levels often fall below CMS expectations.2
Nursing home resources are stretched thin in the effort to keep up with the needs of their populations. The nursing shortage, for example, is a major challenge. According to new payroll-based data, nursing home staffing levels often fall below CMS expectations.2
Avoidable
hospitalizations and readmissions are another concern. The rate of potentially
avoidable readmissions dropped from 12.4% in 2011 to 10.8% in 2016, according
to the Medicare Payment Advisory Commission.3 Although the trend is encouraging, industry
observers believe that rate is still too high.
With the
growth of ISNPs in recent years, nursing homes have more options to adopt
on-site care models. This would potentially result in reduced transfers to
high-cost settings. The researchers concluded that the UnitedHealthcare and
Optum ISNP model is one potential approach to rebalance care away from the ED
and hospital. It may also help inform value-based payment models in the skilled
nursing facility population.
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