As managed care plans become more and more relevant to the nursing home industry, it appears Medicare Advantage beneficiaries are experiencing less favorable outcomes, while using less post-acute care services than those on traditional fee-for-service Medicare.

A study published in JAMA Health Forum on Friday suggests that MA enrollees reported less functional improvement while using post-acute care services, compared to those on traditional Medicare. Similar patterns were seen among dual-eligible beneficiaries, the report found, although differences between MA and traditional dual-eligibles were not statistically significant.

Moreover, JAMA researchers said enrollee perception of MA plans could be tied to use of lower quality SNFs given that beneficiaries are limited to certain practitioners available within MA plan networks.

Another contributor to less favorable outcomes among residents is that MA requires prior authorization for post-acute care services, and plans may delay patient’s receipt of such services or end services before the beneficiary is ready, leading to higher levels of dissatisfaction with care.

Of note are better outcomes among MA enrollees for certain measures, including readmissions and successful discharge to the community.

“These findings highlight the importance of assessing patient-reported outcomes, especially as MA and other payment models seek to reduce inefficient use of postacute care services,” JAMA authors said.

Better evidence is needed to determine if MA plans can control the use of post-acute care services while achieving positive outcomes, researchers said, and patient-reported outcomes are sorely needed to improve care delivery processes.

This is especially important as MA continues to grow in the skilled nursing space, authors said, particularly if “differential service use is associated with perceived differences in care for MA enrollees.”

There’s an interesting parallel between what JAMA authors say is needed in assessing MA outcomes and the call among SNF leaders to include patient satisfaction in the Five-Star Rating System, with more recent efforts to measure patient satisfaction getting defeated.

“It has to be the voice of the consumer,” Zimmet Healthcare Services Group Chief Innovation Officer Steven Littlehale said in a September interview with Skilled Nursing News last year. “We’re struggling and striving for patient-centric care, but sometimes it feels like it’s external stakeholder-centered care, or CMS-centered care. It’s not about the consumer.”

Generally, there’s a call for more patient involvement in measuring care efficiency, by adding to five-star and listening to a growing mass of MA enrollees.

Such findings present implications for Medicare’s value-based payment initiatives, JAMA authors said.

Several Medicare payment models, including the Medicare Shared Savings Program and mandatory bundled payments achieved savings by decreasing post-acute care use without adverse outcomes, according to evaluations of administrative data.

However, feedback from beneficiaries introduces “important evidence” to suggest declines in patient satisfaction that should be investigated – especially as CMS seeks to expand payment models that promote more efficient use of post-acute care services.

Emma Achola, David Stevenson and Laura Keohane authored the study.