Preferred Provider Relationships Between Medicare Advantage Plans and Skilled Nursing Facilities Reduce Switching Out of Plans: An Observational Analysis

TitlePreferred Provider Relationships Between Medicare Advantage Plans and Skilled Nursing Facilities Reduce Switching Out of Plans: An Observational Analysis
Publication TypeJournal Article
Year of Publication2018
AuthorsGoldberg EM, Keohane LM, Mor V, Trivedi AN, Jung H-Y, Rahman M
JournalINQUIRY: The Journal of Health Care Organization, Provision, and Financing
Volume55
Accession Number30175669
KeywordsMedicare,Medicare Advantage,skilled nursing facilities,logistic models,federal health insurance plans
Abstract

Unlike traditional Medicare, Medicare Advantage (MA) plans contract with specific skilled nursing facilities (SNFs). Patients treated in an MA plan’s preferred SNF may benefit from enhanced coordination and have a lower likelihood of switching out of their plan. Using 2011-2014 Medicare enrollment data, the Medicare Healthcare Effectiveness Data and Information Set, and the Minimum Data Set, we examined Medicare enrollees who were newly admitted to SNFs in 2012-2013. We used the Centers for Medicare & Medicaid Services star rating to distinguish between MA plans and show how SNF concentration experienced by patients varies between patients in plans with different star ratings. We found that highly rated MA plans steer their patients to a smaller number of SNFs, and these patients are less likely to switch out of their plans. Strengthening the MA plan–SNF relationship may lower disenrollment rates for SNF beneficiaries, imparting benefits to both patients and payers.

URLhttps://journals.sagepub.com/doi/abs/10.1177/0046958018797412
DOI10.1177/0046958018797412
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