Integrated Home- and Community-Based Services Improve Community Survival Among Independence at Home Medicare Beneficiaries Without Increasing Medicaid Costs.
Citation: Journal of the American Geriatrics Society. 67(7):1495-1501, 2019 07.PMID: 31074846Institution: MedStar Washington Hospital CenterDepartment: Medicine/GeriatricsForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Community Health Services/ec [Economics] | *Health Services for the Aged/ec [Economics] | *Home Care Services/ec [Economics] | *Independent Living/ec [Economics] | *Medicaid/ec [Economics] | *Medicare/ec [Economics] | *Primary Health Care/ec [Economics] | Aged | Aged, 80 and over | Female | Frail Elderly | Humans | Male | Quality of Health Care | Survival Rate | United States/ep [Epidemiology]Year: 2019Local holdings: Available online from MWHC library: 1995 - 2000, then 2006-present, Available in print through MWHC library: 1999 - 2006ISSN:- 0002-8614
| Item type | Current library | Collection | Call number | Status | Date due | Barcode |
|---|---|---|---|---|---|---|
| Journal Article | MedStar Authors Catalog | Article | 31074846 | Available | 31074846 |
Available online from MWHC library: 1995 - 2000, then 2006-present, Available in print through MWHC library: 1999 - 2006
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 ( 151/mo; observed-to-expected ratio = .88 [.68-1.09]). LTI-free survival in the IAH HBPC group was 85% at 36 months, extending average community residence by 12.8 months compared with IAH-q participants in NHATS.
SETTING: Three IAH-participating HBPC sites in Philadelphia, PA, Richmond, VA, and Washington, DC.
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