More than one fifth of Medicare Advantage users classified as homebound or semi-homebound

More than one fifth of Medicare Advantage users classified as homebound or semi-homebound

Homebound status a powerful predictor of hospitalization and health care utilization

Abstract: https://www.acpjournals.org/doi/10.7326/M24-0011

URL goes live when the embargo lifts

A large cross-sectional study of Medicare Advantage (MA) plan beneficiaries found that more than one fifth of participants are homebound or semi-homebound, which is a powerful independent predictor of hospitalization and health care utilization. As MA becomes the majority payer source for Medicare beneficiaries, attention to providing appropriate care delivery to this high-need, high-cost population is warranted. The findings are published in Annals of Internal Medicine. 

Researchers from Johns Hopkins University, Harvard Medical School, and Humana surveyed more than 514,000 Humana MA beneficiaries to determine the prevalence, characteristics, predictors, health service use, and mortality outcomes of homebound beneficiaries. To keep the focus on homebound status, the sample was limited to beneficiaries who completed an in-home health and well-being assessment (IHWA) and were alive and continuously enrolled in a large national MA plan between January and December 2022. The data showed that the overall prevalence of homebound status was 22%. Compared to those who were not homebound, participants who were homebound or semi-homebound were more likely to be older than 85 years old, female, and low-income, and factors associated with homebound status included dementia and moderate-severe frailty. Homebound status was associated with increased odds of emergency department visits, inpatient hospital admissions, skilled nursing facility admissions and mortality. In fact, homebound status was a more powerful predictor of hospitalization than any sociodemographic variable or measure of morbidity burden except level of frailty. Similarly, homebound status was the strongest predictor of skilled-nursing facility admission other than frailty and having an abnormal gait. According to the study authors, these findings can be used to inform strategic initiatives to identify and manage care for homebound beneficiaries.

Media contacts: For an embargoed PDF, please contact Angela Collom at [email protected]. To speak with corresponding author, Bruce Leff, MD, please email Zachary Fulwood at [email protected].