Domain

Evidence (e.g. research results from CER, PCOR, or QI)

Type

Empirical Study

Theme

effectiveness; operations

Start Date

7-6-2014 2:55 PM

End Date

7-6-2014 4:15 PM

Structured Abstract

Objective: Medicare and Medicaid dual eligible population consists of the nation’s most poor and chronically ill individuals. The population comprises 20% of Medicare beneficiaries and 15% of Medicaid beneficiaries, yet account for 31% and 39% of expenditures, respectively. Approximately 1.5 million dual eligible individuals receive home- and community-based services (HCBS). However, research comparing HCBS care models for the dual eligible population is limited due to separate and siloed agencies using different health information system platforms. The purpose of this study was to combine and compare providers’ hours, personnel costs, and patient hospitalizations from two HCBS care models providing services for dual eligible individuals.

Methods: This study was a retrospective analysis of medical record data. The study population consisted of 49 dual eligible individuals enrolled in Health Related Quality of Life: Elders in Long Term Care Study (Mary D. Naylor, PI) who received care from two capitated HCBS programs in northeastern United States between 2007 and 2009. The two HCBS care models were managed long-term care (MLTC) and integrated care (MLTC n=31, Integrated Care n=18). MLTC emphasizes coordinated care and in-home services, whereas integrated care provides inter-professional primary care services and a senior day care center. The dependent variables for this analysis were providers’ hours and personnel costs. Data were collected on providers’ hours for 7 consecutive days per patient at 1- 3- and 6-months after enrollment in HCBS. Personnel costs were estimated using Bureau of Labor Statistics 2012 Occupational Employment and Wages. Hospitalizations or short-term stays in skilled nursing facilities were also collected over 7 consecutive day periods at 1-, 3-, and 6-months after enrollment in HCBS. The baseline enrollment assessment provided function and comorbidity data. We extracted all data from each program’s health information system. The data were standardized across care models and then combined for the statistical analysis. Generalized linear models (GLM) using generalized estimating equations estimated relative ratios of providers’ hours and personnel costs of the two care models while controlling for age, race, ethnicity, function, and comorbidity.

Findings: The study population was older (mean age = 79 years) and primarily Black (56%). The GLM analysis showed that, on average, MLTC providers spent 4.0 times more hours per patient than integrated care providers (p

Discussion: Study findings suggest that HCBS care models with integrated care and senior centers may be more efficient in providing care for dual eligible individuals than care models emphasizing coordinated care and in-home services.

Conclusions: Our findings indicate the feasibility of combining data from HCBS programs that use different health information system platforms. Larger clinical effectiveness studies are needed to better understand which HCBS care models meet this vulnerable population’s needs and desires while delivering quality care.

Acknowledgements

Health Related Quality of Life: Elders in Long Term Care, R01-AG025524, National Institute on Aging and National Institute of Nursing Research, Mary D. Naylor, PI

Individualized Care for At-Risk Older Adults, T32-NR009356, National Institute of Nursing Research, Postdoctoral Research Fellowship

Comparing Home- and Community-Based Long Term Care Programs: A Feasibility Study. NYU University Research Challenge Fund, Janet H. Van Cleave PI

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

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Jun 7th, 2:55 PM Jun 7th, 4:15 PM

Comparing Home- and Community-Based Care Models for Medicare/Medicaid Dual Eligible Individuals

Objective: Medicare and Medicaid dual eligible population consists of the nation’s most poor and chronically ill individuals. The population comprises 20% of Medicare beneficiaries and 15% of Medicaid beneficiaries, yet account for 31% and 39% of expenditures, respectively. Approximately 1.5 million dual eligible individuals receive home- and community-based services (HCBS). However, research comparing HCBS care models for the dual eligible population is limited due to separate and siloed agencies using different health information system platforms. The purpose of this study was to combine and compare providers’ hours, personnel costs, and patient hospitalizations from two HCBS care models providing services for dual eligible individuals.

Methods: This study was a retrospective analysis of medical record data. The study population consisted of 49 dual eligible individuals enrolled in Health Related Quality of Life: Elders in Long Term Care Study (Mary D. Naylor, PI) who received care from two capitated HCBS programs in northeastern United States between 2007 and 2009. The two HCBS care models were managed long-term care (MLTC) and integrated care (MLTC n=31, Integrated Care n=18). MLTC emphasizes coordinated care and in-home services, whereas integrated care provides inter-professional primary care services and a senior day care center. The dependent variables for this analysis were providers’ hours and personnel costs. Data were collected on providers’ hours for 7 consecutive days per patient at 1- 3- and 6-months after enrollment in HCBS. Personnel costs were estimated using Bureau of Labor Statistics 2012 Occupational Employment and Wages. Hospitalizations or short-term stays in skilled nursing facilities were also collected over 7 consecutive day periods at 1-, 3-, and 6-months after enrollment in HCBS. The baseline enrollment assessment provided function and comorbidity data. We extracted all data from each program’s health information system. The data were standardized across care models and then combined for the statistical analysis. Generalized linear models (GLM) using generalized estimating equations estimated relative ratios of providers’ hours and personnel costs of the two care models while controlling for age, race, ethnicity, function, and comorbidity.

Findings: The study population was older (mean age = 79 years) and primarily Black (56%). The GLM analysis showed that, on average, MLTC providers spent 4.0 times more hours per patient than integrated care providers (p

Discussion: Study findings suggest that HCBS care models with integrated care and senior centers may be more efficient in providing care for dual eligible individuals than care models emphasizing coordinated care and in-home services.

Conclusions: Our findings indicate the feasibility of combining data from HCBS programs that use different health information system platforms. Larger clinical effectiveness studies are needed to better understand which HCBS care models meet this vulnerable population’s needs and desires while delivering quality care.