Clinical and Cost Outcomes in Medicare Advantage Following Post-Acute Care

Introduction: Post-acute care (PAC) disposition decisions influence costs and outcomes. Skilled nursing facilities (SNFs) provide intensive oversight, home health agencies (HHA) deliver care in familiar settings, often at lower cost. Comparative effectiveness for clinically similar Medicare Advantage members remains unclear. The purpose of this article is to compare clinical and cost outcomes for Medicare Advantage members discharged to HHA versus SNF after acute hospitalizations using a retrospective, quasi-experimental framework. Methods: Using deidentified medical claims from care organizations across 7 states, we identified members discharged to HHA or SNF following acute hospitalizations. Propensity score matching balanced demographics, clinical characteristics, prior utilization, and social determinants of health. Outcomes included readmissions, mortality, costs, emergency room visits, and primary care utilization. Results: No significant difference in 30-day readmissions (5.9% vs 6.4%, OR 0.91, 95% CI 0.67-1.25) or 90-day mortality (8.2% vs 9.9%, OR 0.81, 95% CI 0.64-1.02). HHA had lower costs at 30 days (−$7510, P < .001). Conclusions: Among Medicare Advantage members with comparable clinical profiles, discharge to home with HHA yields similar clinical outcomes at substantially lower cost than SNF. These savings present opportunities to reinvest in transitional care programs and address social determinants of health within the home setting. Findings support consideration of home-based care as a cost-effective alternative for appropriate members.