Home-Based Medical Care in Traditional Medicare vs. Medicare Advantage Among Older Adults With Alzheimer's Disease and Related Dementias.

BACKGROUND

As Alzheimer's disease and related dementias (ADRD) progress, many people become homebound and depend on home-based medical care (HBMC), but differences in HBMC, telemedicine, and office visits between Traditional Medicare (TM) and Medicare Advantage (MA) plans are not well understood.

METHODS

We analyzed 2021-2022 Medicare claims and encounter data to categorize 2022 outpatient visits for community-living TM and MA enrollees with ADRD as HBMC, telemedicine, or office-based. We summarized HBMC recipient characteristics by plan type and used Poisson regression with inverse weights of propensity of plan enrollment and regional fixed effects to compare TM and MA enrollees on visit counts, usage incidence, and visit intensity by visit modality. We also examined differences by comorbidity burden, frailty, dual Medicaid eligibility, race and ethnicity, and major MA plans.

RESULTS

Out of 49,194 TM and 47,830 MA enrollees with ADRD, MA enrollees had fewer overall visits (TM = 8.89; MA = 7.97) and HBMC visits (TM = 2.09; MA = 1.37) compared to TM enrollees. Adjusted analyses showed that the number of HBMC visits was 25% lower (IRR = 0.75; 95% CI, 0.69-0.81) in MA compared to TM, arising from 19% and 7% lower user incidence and visit intensity, respectively. Office visits were 6% lower (IRR = 0.94; 95% CI, 0.91-0.96), telemedicine visits were similar (IRR = 1.02; 95% CI, 0.95-1.10), and overall visits were 10% lower (IRR = 0.90; 95% CI, 0.88-0.93) in MA relative to TM. Relative to TM, HBMC visits were lower in MA by a larger margin among non-Hispanic Black (47%), Hispanic (67%), and dual Medicaid-eligible (42%) MA enrollees. Within MA, HBMC visits were 27% higher (IRR = 1.27; 95% CI, 1.09-1.48) in PPO plans relative to HMO plans.

CONCLUSIONS

HBMC user incidence and visit intensity were higher in TM than MA among enrollees with ADRD. The findings underscore the need for research and targeted interventions to ensure adequate and equitable access to HBMC services.