Authors
Cyrus M Kosar, Jeffrey Marr, Huiying Wang, Emily A Gadbois, Elizabeth M White, Fangli Geng, Vincent Mor, David J Meyers, Momotazur Rahman
Published in
Health affairs (Project Hope). Volume 45. Issue 11. Pages 1278-1286.
Abstract
Capitation incentivizes Medicare Advantage (MA) plans to contract with providers willing to accept lower prices, and providers participating in MA are subject to managed care administrative burdens. Policy makers and researchers have raised concerns that these features may limit network breadth and reduce MA enrollees' access to high-quality providers, but the evidence is limited. We examined this issue in the high-risk and frequently used skilled nursing facility (SNF) setting. We linked 2022 data from MA provider directories, Medicare hospital claims, and SNF admission assessments to characterize SNF network breadth for MA enrollees and the quality of SNFs in different-size MA networks. We then compared the quality and proximity of SNFs where traditional Medicare and MA enrollees in plans with different-size networks in the same neighborhoods were discharged. Compared with traditional Medicare enrollees, MA enrollees in narrow and broad networks were 22 percent and 13 percent less likely, respectively, to enter five-star SNFs and were 18 percent and 5 percent less likely to be discharged to the SNFs nearest their residences. Our findings suggest that policy efforts to enhance MA networks may be needed to improve SNF access and quality in MA.
PMID:
42970727
Bibliographic data and abstract were imported from PubMed on 03 Nov 2026.
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