Annals of internal medicine · 2026
Diagnosis and Treatment of Cardiovascular Conditions in Medicare Advantage In-Home Health Risk Assessments.
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Oseran Andrew S, Liu-Hass Michael, Shanab Bassel M, Zheng Zhaonian, Lalani Christina, Yeh Robert W, Wadhera Rishi K
Аннотация
BACKGROUND: Medicare Advantage insurers conduct in-home health risk assessments (HRAs) to identify high-risk patients and facilitate appropriate care. Critics argue this practice increases risk-adjusted payments without improving quality. Comprehensive data on use of in-home HRAs and downstream treatment are lacking.
OBJECTIVE: To examine trends in cardiovascular conditions diagnosed during in-home HRAs, characteristics associated with HRA-based diagnoses, and treatment rates after diagnoses.
DESIGN: Cohort study.
SETTING: Population-based.
PARTICIPANTS: Medicare Advantage beneficiaries.
MEASUREMENTS: Using 100% Medicare claims, trends in the proportion of cardiovascular conditions diagnosed during in-home HRAs (vs. facility-based visits) were examined. Multivariable logistic regression models were fit to estimate the association between beneficiary- and plan-level characteristics and HRA-based diagnoses and compare treatment rates across settings.
RESULTS: Among 21 496 506 Medicare Advantage beneficiaries diagnosed with a cardiovascular risk factor or disease, the proportion diagnosed during in-home HRAs increased between 2018 and 2022 for hypertension (45.9% to 47.7%), hyperlipidemia (57.8% to 66.7%), diabetes (47.8% to 51.6%), atrial fibrillation (30.0% to 36.0%), ischemic heart disease (37.2% to 41.6%), peripheral vascular disease (64.5% to 73.9%), and heart failure (34.7% to 42.6%). Racial and ethnic minority beneficiaries and those enrolled in lower-rated plans were more likely to receive HRA-based diagnoses. Treatment rates were substantially lower after HRA-based diagnoses across all conditions.
LIMITATIONS: Differences in the severity of conditions between groups could not be assessed. Prescription fills were used as a proxy for management. Observed differences in the diagnosis and treatment of conditions across encounter settings may be susceptible to unmeasured confounding.
CONCLUSION: Among Medicare Advantage beneficiaries, an increasingly large share of cardiovascular conditions are being diagnosed through in-home HRAs, but treatment rates after these diagnoses are consistently lower than after facility-based encounters.
PRIMARY FUNDING SOURCE: National Heart, Lung, and Blood Institute.
OBJECTIVE: To examine trends in cardiovascular conditions diagnosed during in-home HRAs, characteristics associated with HRA-based diagnoses, and treatment rates after diagnoses.
DESIGN: Cohort study.
SETTING: Population-based.
PARTICIPANTS: Medicare Advantage beneficiaries.
MEASUREMENTS: Using 100% Medicare claims, trends in the proportion of cardiovascular conditions diagnosed during in-home HRAs (vs. facility-based visits) were examined. Multivariable logistic regression models were fit to estimate the association between beneficiary- and plan-level characteristics and HRA-based diagnoses and compare treatment rates across settings.
RESULTS: Among 21 496 506 Medicare Advantage beneficiaries diagnosed with a cardiovascular risk factor or disease, the proportion diagnosed during in-home HRAs increased between 2018 and 2022 for hypertension (45.9% to 47.7%), hyperlipidemia (57.8% to 66.7%), diabetes (47.8% to 51.6%), atrial fibrillation (30.0% to 36.0%), ischemic heart disease (37.2% to 41.6%), peripheral vascular disease (64.5% to 73.9%), and heart failure (34.7% to 42.6%). Racial and ethnic minority beneficiaries and those enrolled in lower-rated plans were more likely to receive HRA-based diagnoses. Treatment rates were substantially lower after HRA-based diagnoses across all conditions.
LIMITATIONS: Differences in the severity of conditions between groups could not be assessed. Prescription fills were used as a proxy for management. Observed differences in the diagnosis and treatment of conditions across encounter settings may be susceptible to unmeasured confounding.
CONCLUSION: Among Medicare Advantage beneficiaries, an increasingly large share of cardiovascular conditions are being diagnosed through in-home HRAs, but treatment rates after these diagnoses are consistently lower than after facility-based encounters.
PRIMARY FUNDING SOURCE: National Heart, Lung, and Blood Institute.