For home health agencies negotiating MA contracts, this study provides quantitative evidence that episodic payment terms – which preserve clinical flexibility – are associated with better patient outcomes than per-visit arrangements.
Medicare Advantage Reimbursement Structures Impact Home Health Delivery and Outcomes
Per-visit MA plans dictate the total number of visits — and the number of visits per discipline — covered during a specified duration of days, and the agency must seek reauthorization for additional covered days or visits. Compared with traditional Medicare, per-visit MA had a 6% higher likelihood of inpatient transfers (95% CI, 1.02–1.10). Comparing MA plan types, per-visit MA had a 12% higher likelihood of inpatient transfers (95% CI, 1.06–1.18) than episodic MA. Episodic MA plans, which allow home health agencies flexibility in determining visit delivery, may have fewer adverse inpatient transfer outcomes compared with MA plans that dictate the amount and type of care provided.
— The American Journal of Managed Care, November 6, 2025
Prusynski, Rachel A. et al. “Medicare Advantage Reimbursement Structures Impact Home Health Delivery and Outcomes.” The American Journal of Managed Care, Nov. 2025. https://www.ajmc.com/view/medicare-advantage-reimbursement-structures-impact-home-health-delivery-and-outcomes.
✔ Comply with every payer's rules
✔ Equip your team with the Playbook
✔ Monitor rates and payer trends
