Fangli Geng, doctoral student in Health Policy concentrating in Decision Science, successfully defended her thesis, “Assessing Value and Optimizing Decision-Making in Post-Acute Care Across Diverse Populations.” Her dissertation committee was chaired by David Grabowski and included Stephen Resch, Meredith Rosenthal and José Zubizarreta.
In her dissertation, Geng investigated the enhancement of value in post-acute care (PAC) within the U.S. healthcare system, focusing on the largest source of variation in Medicare costs. She combined individual preferences, clinical evidence, and payment model impacts to provide comprehensive insights into PAC. Overall, her dissertation offered significant insights into improving the efficiency, quality, and equity of PAC discharge practices and payment model designs.
Using primary data and choice modeling, Geng examined the preferences of patients and caregivers for facility-based versus home-based care. There was a strong preference for high-quality, home-based care; however, preferences shifted towards facility-based care under conditions of high caregiving burden or socioeconomic challenges. There was consistent willingness to pay more for home-based care across varied demographics, especially among those with prior PAC experience. While home-based care is generally preferred, policy considerations must be tailored to support disadvantaged groups facing unique challenges.
Geng also compared health outcomes between skilled-nursing facilities and home-based services, using an instrumental variable design to minimize selection bias. The analysis, covering traditional Medicare beneficiaries from 2013-2017, revealed no significant differences in mortality or rehospitalization rates between the two settings. However, higher Medicare spending occurred in skilled-nursing facilities for specific patient cohorts. This research underscored the importance of cost-effective discharge planning and can inform policy decisions for optimizing post-acute care referrals.
Finally, Geng evaluated the implications of expanding Medicare Advantage (MA) on traditional Medicare PAC utilization and found that increased MA market penetration was associated with reduced PAC use in traditional Medicare without an increase in hospital readmissions. The findings highlighted the influence of MA expansion on PAC use and suggest the need for policymakers to consider MA penetration in the evaluation of alternative payment methods.
Learn more: Read the paper, Increased Medicare Advantage Penetration Is Associated With Lower Postacute Care Use For Traditional Medicare Patients
Learn more: Read about Preferences and Values
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