Hospital-Operated Medicare Advantage Plans and Care Utilization and Outcomes After Inpatient Admissions.

IMPORTANCE

Many health systems are integrating care delivery and financing by operating their own Medicare Advantage (MA) plans. Although these hospital-operated MA plans may improve care coordination and efficiency, their implications for care utilization and patient outcomes remain unclear.

OBJECTIVE

To assess whether enrollment in hospital-operated MA plans is associated with differences in care utilization or health outcomes after major inpatient admissions.

DESIGN, SETTING, AND

PARTICIPANTS

This cross-sectional study used 2022 national Medicare data to compare 90-day care utilization and clinical outcomes after major inpatient admissions occurring between January 1, 2022, and September 30, 2022, among MA beneficiaries enrolled in hospital-operated MA plans vs other MA plans. Analyses adjusted for patient characteristics and county fixed effects, with inverse probability weighting to address potential patient selection. Data were analyzed from April 2025 to June 2026.

EXPOSURE: Enrollment in hospital-operated MA plans.

MAIN OUTCOMES AND MEASURES: Primary outcomes included rates of subsequent all-cause inpatient admissions, emergency department visits, observational stays, skilled nursing facility use, inpatient rehabilitation or long-term acute care use, length of subsequent inpatient and skilled nursing facility stays, mortality, and number of healthy days at home, all measured within 90 days of discharge. The secondary outcome was total episode spending, including spending during both the index admission and in the 90 days after discharge.

RESULTS

The sample included 2278 MA plans offered in 2022, 332 (14.6%) of which were identified as hospital-operated MA plans. Across these plans, 468 441 major inpatient episodes related to 1 of 10 high-volume, high-cost medical or surgical conditions were identified, 75 662 (16.2%) of which were covered by hospital-operated MA plans. Compared with beneficiaries in other MA plans, hospital-operated MA plan enrollees were older, more often male and Hispanic, less likely to be non-Hispanic Black, and less likely to be dually eligible for Medicaid. After adjustment, hospital-operated MA plan enrollment was associated with lower rates of skilled nursing facility use (15.4% vs 18.3%; adjusted difference, -2.9 [95% CI, -3.2 to -2.6] percentage points [pp]) and observational stays (10.2% vs 11.6%; adjusted difference, -1.3 [95% CI, -1.6 to -1.1] pp) and higher rates of inpatient rehabilitation and/or long-term acute care services use (1.8% vs 1.0%; adjusted difference, 0.8 [95% CI, 0.8 to 0.9] pp) and readmissions (26.9% vs 25.0%; adjusted difference, 1.8 [95% CI, 1.5 to 2.1] pp), with no significant differences in emergency department visits. Despite these shifts in care utilization, hospital-operated MA plan enrollees experienced more healthy days at home (71.75 vs 71.52 days; adjusted difference, 0.23 [95% CI, 0.06 to 0.44] days) and no significant differences in mortality. Overall, hospital-operated MA plan enrollment was associated with lower episode spending ($24 072 vs $24 244; adjusted difference, -$172 [95% CI, -$291 to -$53]), with patterns broadly consistent across medical conditions and surgical procedures.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of major inpatient episodes among MA beneficiaries, hospital-operated MA plan enrollment was associated with distinct post-acute care utilization patterns, lower episode spending, and no evidence of worse clinical outcomes. These findings suggest that vertical integration between health systems and health plans may be associated with more efficient and coordinated care delivery.