Guided Care: Cost and Utilization Outcomes in a Pilot Study

Sylvia, Martha; Griswold, Michael; Dunbar, Linda; Boyd, Cynthia M.; Park, Margaret; Boult, Chad

doi:10.1089/dis.2008.111723

Cited by 58 publications

(49 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This offers a tempting target for efforts to reduce that utilization. Some enthusiasm has been generated about the potential for introducing better primary care for nursing home residents and thereby saving money for Medicare (Grabowski, O'Malley, & Barhydt, 2007;Ouslander et al, 2010;Saliba et al, 2000;Sylvia et al, 2008), but so far few such efforts have been effective (Peikes, Chen, Schore, & Brown, 2009). One successful model was developed by Evercare, a Medicare Advantage institutional Special Needs Program; it used aggressive care from nurse practitioners to treat nursing home residents in the nursing home and paid the nursing homes for agreeing to retain such patients (Kane, Keckhafer, Flood, Bershadsky, & Siadaty, 2003).…”

Section: Resultsmentioning

confidence: 99%

Effect of Long-term Care Use on Medicare and Medicaid Expenditures for Dual Eligible and Non-dual Eligible Elderly Beneficiaries

Kane¹,

Wysocki²,

Parashuram³

et al. 2013

MMRR

View full text Add to dashboard Cite

Results: Among dual eligibles and non-dual eligibles, the average number of diseases and case mix scores are higher for LTC users. Adjusting for case mix virtually eliminates the difference for medical costs, but not for LTC expenditures. Adjusting for LTC status reduces the difference in LTC costs, but increases the difference in medical costs. Conclusions:Efforts to control costs for dual eligibles should target those in LTC while better coordinating medical and LTC expenditures. Access, Demand Uninsured, 2011Uninsured, , 2012 Kane, Homyak, Parashuram, Lee, & Woodhouse, 2008; Kasper, Watts, & Lyons, 2010; Young, Garfield, Musumeci, Clemens-Cope, Lawton, 2012). However, the data are mainly descriptive and do not account for the role of casemix or other characteristics. One explanation for disproportionate costs is that double program coverage results in overlaps and inefficiencies, leading to proposed solutions such as integrated care (Gold, Jacobson, & Garfield, 2012;Meyer, 2012;Neuman, Lyons, Rentas, & Rowland, 2012). There is a clear need to identify the specific characteristics of Medicare-Medicaid enrollees that account for their disproportionately high expenditures for medical and long-term care. Keywords:The only study to examine the effect of casemix on Medicare-Medicaid enrollees' higher LTC costs found that they were largely attributable to greater levels of dysfunction and disease burden (Liu, Long, & Aragon, 1998). Our study builds upon this work with more recent data and a separate examination of the role of LTC care setting and case mix for elderly MedicaidMedicare beneficiaries. We analyzed Medicare and Medicaid data to examine how type of long-term care and case mix affect expenditures towards medical care and LTC for older MedicareMedicaid enrollees and non-duals, and how these expenditures vary between programs and settings. In response to the findings of Bubolz, Emerson, and Skinner (2012), we also looked for evidence of de facto cross-subsidization among those covered by both Medicare and Medicaid; namely, was nursing home use (covered only by Medicaid) associated with lower medical care use (covered by Medicare)? Methods Study PopulationOur study population consists of individuals aged 65 years and older in 2005, enrolled in (1) Medicaid only, (2) Medicare only, and (3) Medicare and Medicaid simultaneously. We selected residents from seven states (Arkansas, Florida, Minnesota, New Mexico, Texas, Vermont, and Washington) who illustrate diverse management techniques across the target populations, and diverse state characteristics; e.g., demographics, size, geography, structure of county government, and policies. The LTC waiver, state plan programs, and plan variations are summarized in Appendix Exhibit A1. All of the states had an aging and disability waiver.In order to analyze the characteristics and expenditures of duals and non-dual beneficiaries based on LTC utilization, we classified our study sample into four groups based on program enrollment and LTC use: MMRR 2013: Volume 3 ...

show abstract

Section: Resultsmentioning

confidence: 99%

Effect of Long-term Care Use on Medicare and Medicaid Expenditures for Dual Eligible and Non-dual Eligible Elderly Beneficiaries

Kane¹,

Wysocki²,

Parashuram³

et al. 2013

MMRR

View full text Add to dashboard Cite

show abstract

“…18 Adding geriatricians to primary care reduces hospitalizations and total health care costs. 19 Public health personnel are important additions to the multidisciplinary team.…”

Section: Can Prevention Flatten the Curve?mentioning

confidence: 99%

Confronting The Growing Burden Of Chronic Disease: Can The U.S. Health Care Workforce Do The Job?

Chen²,

2009

View full text Add to dashboard Cite

The U.S. chronic illness burden is increasing and is felt more strongly in minority and low-income populations: in 2005, 133 million Americans had at least one chronic condition. Prevention and management of chronic disease are best performed by multidisciplinary teams in primary care and public health. However, the future health care workforce is not projected to include an appropriate mix of personnel capable of staffing such teams. To prepare for the growing chronic disease burden, a larger interdisciplinary primary care workforce is needed, and payment for primary care should reward practices that incorporate multidisciplinary teams. [Health Affairs 28, no. 1 (2009): 64-74; 10.1377/hlthaff .28.1.64] I n 2 0 0 5 , 13 3 m i ll i o n a m e r i c an s w e r e l i v i n g with at least one chronic condition. In 2020, this number is expected to grow to 157 million. In 2005, sixty-three million people had multiple chronic illnesses, and that number will reach eighty-one million in 2020. 1 Not surprisingly, the proportion of the population diagnosed with chronic conditions increases with age (Exhibit 1). More worrisome is the striking gap between the high prevalence of chronic conditions among people who are below the federal poverty level compared with the average prevalence in the general population. The cost burden of chronic illness-currently 78 percent of total health spending-will increase markedly by 2023 (Exhibit 2). The number of people with diabetes is expected to double in the next twenty-five years, from twentyfour million to forty-eight million. By 2023, the number of people with chronic mental disorders may increase from thirty million to forty-seven million. Similar increases are forecast for virtually every common chronic condition. 6 4 J a n u a r y / F e b r u a r y 2 0 0 9 R e o r g a n i z i n g C a r e n Reasons for increased prevalence. Reasons for the increased prevalence of chronic conditions are multifactorial-including an aging population plus a rise in disease-specific risk factors such as obesity. A comparison of chronic disease prevalence in the United States and in ten European countries reveals a markedly lower prevalence in Europe of heart disease, hypertension, diabetes, obesity, and arthritis. This difference may be attributable to a healthier diet and lower poverty rates in Eu- 4 The population over age eighty-five, the group with the highest proportion of people with multiple chronic conditions, is projected to grow from five million in 2005 to twenty-one million in 2050, ensuring a major increase in the number of very-high-cost patients.n Four policy questions. These data raise both general societal issues and specific policy questions. In this paper we address four specific policy questions, with greatest emphasis placed on questions 2 and 3: (1) Can dramatic public health prevention slow down the rate of increase of chronic disease prevalence? (2) Should chronic care be delivered chiefly by specialist physicians, generalist physicians, or multidisciplinary teams...

show abstract

“…36 Preliminary evidence suggests that this "streamlined" approach doesn't require major practice redesign; however, efficient use of the dedicated Guided Care RN would usually require the number of chronic care patients served by several physicians. 37 n Patient populations served by the medical home. There remains a lack of agreement about whether the PCMH is designed to target subpopulations, as the pediatric medical home does.…”

Section: Challenges To Pcmh Adoptionmentioning

confidence: 99%

A House Is Not A Home: Keeping Patients At The Center Of Practice Redesign

Berenson¹,

Hammons²,

Gans³

et al. 2008

Health Affairs

211

171

View full text Add to dashboard Cite

The patient-centered medical home could well be a transformative innovation-for some practices now, but for many others only in the long run.by Robert A. Berenson, Terry Hammons, David N. Gans, Stephen Zuckerman, Katie Merrell, William S. Underwood, and Aimee F. Williams ABSTRACT: The "patient-centered medical home" has been promoted as an enhanced model of primary care. Based on a literature review and interviews with practicing physicians, we find that medical home advocates and physicians have somewhat different, although not necessarily inconsistent, expectations of what the medical home should accomplish-from greater responsiveness to the needs of all patients to increased focus on care management for patients with chronic conditions. As the medical home concept is further developed, it will be important to not overemphasize redesign of practices at the expense of patient-centered care, which is the hallmark of excellent primary care. T h e pat i e n t-c e n t e r e d m e d i c a l h o m e (PCMH) is the newest idea being promoted as a transformative health system innovation. Proponents believe that it will improve the quality of and patients' experiences with care and alter the trajectory of inflationary health care spending. 1 The PCMH has been proposed by four primary care physician specialty societies; has been endorsed by a range of purchaser, labor, and consumer organizations, including IBM, Merck and Company, the ERISA Industry Committee, and AARP; and is being tested in demonstrations by major public and private health plans, including Medicare, various Blue Cross and Blue Shield plans, UnitedHealthcare, and Aetna. 2 The medical P r a c t i c e R e d e s i g n H E A LT H A F F A I R S~Vo l u m e 2 7, N u m b e r 5 1 2 1 9

show abstract

Guided Care: Cost and Utilization Outcomes in a Pilot Study

Cited by 58 publications

References 16 publications

Effect of Long-term Care Use on Medicare and Medicaid Expenditures for Dual Eligible and Non-dual Eligible Elderly Beneficiaries

Effect of Long-term Care Use on Medicare and Medicaid Expenditures for Dual Eligible and Non-dual Eligible Elderly Beneficiaries

Confronting The Growing Burden Of Chronic Disease: Can The U.S. Health Care Workforce Do The Job?

A House Is Not A Home: Keeping Patients At The Center Of Practice Redesign

Contact Info

Product

Resources

About