TY  - BOOK
AU  - De Jonge, K Eric
AU  - Taler, George
TI  - Integrated Home- and Community-Based Services Improve Community Survival Among Independence at Home Medicare Beneficiaries Without Increasing Medicaid Costs
SN  - 0002-8614
PY  - 2019///
KW  - *Community Health Services/ec [Economics]
KW  - *Health Services for the Aged/ec [Economics]
KW  - *Home Care Services/ec [Economics]
KW  - *Independent Living/ec [Economics]
KW  - *Medicaid/ec [Economics]
KW  - *Medicare/ec [Economics]
KW  - *Primary Health Care/ec [Economics]
KW  - Aged
KW  - Aged, 80 and over
KW  - Female
KW  - Frail Elderly
KW  - Humans
KW  - Male
KW  - Quality of Health Care
KW  - Survival Rate
KW  - United States/ep [Epidemiology]
KW  - MedStar Washington Hospital Center
KW  - Medicine/Geriatrics
KW  - Journal Article
N1  - Available online from MWHC library: 1995 - 2000, then 2006-present, Available in print through MWHC library: 1999 - 2006
N2  - CONCLUSION: HBPC integrated with long-term support services delays LTI in frail, medically complex Medicare beneficiaries without increasing HCBS costs; Copyright (c) 2019 The American Geriatrics Society; DESIGN: Case-cohort study using HBPC site, Medicare administrative data, and National Health and Aging Trends Study (NHATS) benchmarks; INTERVENTION: HBPC integrated with LTSS under IAH demonstration incentives; MEASUREMENTS: Measurements include LTI rate and mortality rates, community survival, and LTSS costs; OBJECTIVES: To determine the effect of home-based primary care (HBPC) for frail older adults, operating under Independence at Home (IAH) incentive alignment on long-term institutionalization (LTI); PARTICIPANTS: HBPC integrated with long-term services and supports (LTSS) cases (n = 721) and concurrent comparison groups (HBPC not integrated with LTSS: n = 82; no HBPC: n = 573). Cases were eligible if enrolled at one of the three HBPC sites from 2012 to 2015. Independence at Home-qualified (IAH-Q) concurrent comparison groups were selected from Philadelphia, PA; Richmond, VA; and Washington, DC; RESULTS: The LTI rate in the three HBPC programs (8%) was less than that of both concurrent comparison groups (IAH-Q beneficiaries not receiving HBPC, 16%; patients receiving HBPC but not in the IAH demonstration practices, 18%). LTI for patients at each HBPC site declined over the three study years (9.9%, 9.4%, and 4.9%, respectively). Costs of home- and community-based services (HCBS) were nonsignificantly lower among integrated care patients (; SETTING: Three IAH-participating HBPC sites in Philadelphia, PA, Richmond, VA, and Washington, DC
UR  - https://dx.doi.org/10.1111/jgs.15968
ER  -