Healthcare Service Use of Elderly Seasonal Migrators

Tuesday, June 14, 2016
Lobby (Annenberg Center)

Author(s): Molly M. Jeffery; Sarah Meier; Jean Abraham; Bryan Dowd; Julian Wolfson; Robert L. Kane


Objective. To explore the use of healthcare services by elderly seasonal migrators and determine whether having local access to primary care reduces their rate of primary care treatable (PCT) Emergency Department (ED) visits.

Background.Little is known about the healthcare behaviors of “Snowbirds”—elders who migrate seasonally, traveling between a summer and winter home. The increased take-up of Medicare Advantage, which frequently include extensive managed care features, and the advent of ACOs and other delivery models requiring increased provider financial responsibility for all healthcare their members use, regardless of their location, make it more relevant than ever to understand the healthcare service use of seasonal migrators.

We use claims data on fee-for-service Medicare beneficiaries’ locations throughout the year to 1) identify seasonal migrators and 2) describe the care they receive in each seasonal home, focusing on primary care and ED visits and the relationships between the two.

Study Design. Medicare claims data (2011-2012) were used to identify services provided to age-eligible fee-for-service beneficiaries. We used providers’ addresses to infer beneficiaries’ locations at the time they received care. Primary care and ED visits were tabulated by season and location for each beneficiary.

Migrators were defined as people observed in both northern and southern states; Snowbirds were migrators observed in the north during summer and fall months and the south in winter and spring. Their healthcare service use was classified according to whether they had local primary care at the time of treatment (i.e., people with primary care either in both locations or those with primary care only in the location where they were when they required care were compared with people without any primary care and those with primary care only in the seasonal home they were not at when they required care). Both migrators and non-migrators were included in the analysis to control for geographic variation in healthcare service provision and coding practices.

Principal Findings.Four percent of beneficiaries were identified as “Snowbirds.” Snowbirds were more likely to be white and less likely to receive Medicaid than other beneficiaries; nearly all  Snowbirds (95%) received some primary care during the study period. Half (49%) received primary care near both winter and summer homes.

ED visit rates were compared for Snowbirds with and without local primary care. Having local primary care was associated with a 58% reduction in PCT ED visits.

Conclusions. We were able to use claims data to identify Snowbirds in a Medicare population. Our results suggest that having local primary care is associated with significantly fewer primary care treatable ED visits.

Because we rely on claims data to determine where people live, this analysis is most applicable to the population of Medicare beneficiaries who can be tracked relatively well using claims, that is, people who receive enough care that their seasonal movements are apparent. Nevertheless, in the absence of any other information about the healthcare service use of this population, this analysis provides insight into the health behaviors of a group that will be increasingly important for providers to understand.