In 2018, more than three million Medicare beneficiaries received skilled nursing and therapy services through the Medicare home health (HH) benefit. Medicare HH users are more likely to be Black, and they tend to be older, less wealthy, and have more chronic conditions compared with other Medicare beneficiaries. HH is a unique health service because the care is delivered in patients’ homes, making both individual-and neighborhood-level characteristics particularly important given our knowledge about individual and place-based disparities as well as neighborhoods’ impacts on access to care and health outcomes.
Research led by Dr. Shekinah Fashaw-Walters found that Black and Hispanic Medicare beneficiaries are 5.6 and 10.9 percentage points less likely to use high-quality HH than white Medicare beneficiaries. Previous University of Minnesota research establishes that neighborhoods with higher concentrations of Black, Hispanic, and lower-income residents have decreased access to higher-quality HH providers. Despite the growth in HH utilization and the racial inequities in use and quality of HH services, research on racial inequities in HH care is sparse.
To incentivize and improve the delivery of higher-quality care, the Centers for Medicare & Medicaid Services (CMS) is expanding the 2016 Home Health Value-Based Purchasing (HHVBP) pilot program across all states. In 2016, CMS piloted a mandatory and randomized nine-state HHVBP model that pays increased rates to HH providers providing higher-quality or more-efficient HH services.
This project aims to achieve the following:
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compare racial and ethnic inequities in high-quality home health agency use between states with and without HHVBP, before and after the program pilot began
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examine whether HHVBP mediates the relationship between neighborhood-level factors and racial and ethnic inequities in high-quality home health agency use for home health patients