Health Affairs study finds disparities in access to high-quality home health agencies

A new study found disparities among race, ethnic and income factors in the use of home health services, with residential segregation a key reason.

The research was published Monday in the latest issue of the journal Health Affairs. It comes as experts predict care will continue to shift from healthcare facilities to the home, which is a major space of interest for payers.

Researchers found racial, ethnic and socioeconomic inequities put “high-quality home health agency services ‘out of reach’ for the most vulnerable Medicare home health patients,” the study said.

It looked at Medicare beneficiary data from 2016 to identify home health recipients, the agency serving them and other individual-level information such as race or living arrangements. Home health agencies also must have a publicly reported star ratings detailed on the Centers for Medicare & Medicaid Services’ (CMS') Care Compare website.

The researchers’ sample consisted of 3.1 million Medicare beneficiaries in home health in 2016.

Black home health patients overall had a 5.6 percentage point lower probability of using a high-quality home health agency and Hispanics by nearly 11 percentage points.

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One of the key drivers of this inequity was location, as prior research has shown that providers are less likely to serve predominantly Black, Hispanic and disadvantaged neighborhoods, the study said.

“Between 40% and 77% of the observed individual-level racial, ethnic and socioeconomic disparities in the use of high-quality home health agencies was attributable to neighborhood-level factors,” the study said.

But the disparities didn’t just exist between different neighborhoods, although they were more pronounced. Researchers also found a lack of access among racial and ethnic lines among beneficiaries in the same neighborhood.

“We found that Black and Hispanic home health patients had a 2.2 percentage point and 2.5 percentage point lower adjusted probability of high-quality agency use, respectively compared with their White counterparts within the same neighborhoods,” the study said.

Low-income patients also had a smaller chance—1.2 percentage points—of using a high-quality home health agency compared to a beneficiary with a higher income.

The study called for policymakers to find ways to dismantle structural and institutional barriers of racism and incentivize providers to serve in more vulnerable areas.

“Ensuring equitable access and aging for all older adults means taking the necessary steps to put high-quality home health agencies within the reach of the most marginalized,” the study said.

It comes as the Biden administration has made addressing health equities a major pillar of its health policy agenda.

CMS’ proposed Part D and Medicare Advantage notice released last week aims to update star ratings for MA and Part D plans to account for how well they tackle equity. This includes access to key benefits for transportation and housing security.