Managed care for long-stay nursing home residents: an evaluation of Institutional Special Needs Plans

Abstract

Objectives: To evaluate the patterns of clinical service use for long-term nursing home residents enrolled in UnitedHealthcare's Medicare Advantage Institutional Special Needs Plans (I-SNPs), which provide on-site direct coordinated care for beneficiaries through the use of advanced practice clinicians.

Study design: Observational analysis of 8052 I-SNP members and 12,982 Medicare fee-for-service (FFS) long-term nursing home residents across 13 states.

Methods: Multivariate analyses were performed to compare rates of emergency department (ED), inpatient, and skilled nursing facility (SNF) use between I-SNP members and Medicare FFS long-term nursing home residents.

Results: In comparison with FFS institutionalized Medicare beneficiaries, I-SNP members had 51% lower ED use, 38% fewer hospitalizations, and 45% fewer readmissions, whereas their SNF use was 112% higher.

Conclusions: "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.