• Brian E McGarry and David C Grabowski.
• Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Boston, MA 02115-5899. Email: Grabowski@med.harvard.edu.
• Am J Manag Care. 2019 Sep 1; 25 (9): 438-443.

ObjectivesTo evaluate the patterns of clinical service use for long-term nursing home residents enrolled in UnitedHealthcare's Medicare Advantage Institutional Special Needs Plans (I-SNPs), which provide on-site direct coordinated care for beneficiaries through the use of advanced practice clinicians.Study DesignObservational analysis of 8052 I-SNP members and 12,982 Medicare fee-for-service (FFS) long-term nursing home residents across 13 states.MethodsMultivariate analyses were performed to compare rates of emergency department (ED), inpatient, and skilled nursing facility (SNF) use between I-SNP members and Medicare FFS long-term nursing home residents.ResultsIn comparison with FFS institutionalized Medicare beneficiaries, I-SNP members had 51% lower ED use, 38% fewer hospitalizations, and 45% fewer readmissions, whereas their SNF use was 112% higher.Conclusions"At-risk" models, administered through specialized Medicare Advantage plans, that invest in clinical management in the nursing home setting have the potential to allow individuals to receive care on-site and avoid costly inpatient transfers.

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