Comprehensive home-based care coordination for vulnerable elders with dementia: Maximizing Independence at Home-Plus—Study protocol

Research output: Contribution to journalArticle

Abstract

Introduction: Despite availability of effective care strategies for dementia, most health care systems are not yet organized or equipped to provide comprehensive family-centered dementia care management. Maximizing Independence at Home-Plus is a promising new model of dementia care coordination being tested in the U.S. through a Health Care Innovation Award funded by the Centers for Medicare and Medicaid Services that may serve as a model to address these delivery gaps, improve outcomes, and lower costs. This report provides an overview of the Health Care Innovation Award aims, study design, and methodology. Methods: This is a prospective, quasi-experimental intervention study of 342 community-living Medicare–Medicaid dual eligibles and Medicare-only beneficiaries with dementia in Maryland. Primary analyses will assess the impact of Maximizing Independence at Home-Plus on risk of nursing home long-term care placement, hospitalization, and health care expenditures (Medicare, Medicaid) at 12, 18 (primary end point), and 24 months, compared to a propensity-matched comparison group. Discussion: The goals of the Maximizing Independence at Home-Plus model are to improve care coordination, ability to remain at home, and life quality for participants and caregivers, while reducing total costs of care for this vulnerable population. This Health Care Innovation Award project will provide timely information on the impact of Maximizing Independence at Home-Plus care coordination model on a variety of outcomes including effects on Medicaid and Medicare expenditures and service utilization. Participant characteristic data, cost savings, and program delivery costs will be analyzed to develop a risk-adjusted payment model to encourage sustainability and facilitate spread.

Original languageEnglish (US)
Pages (from-to)123-134
Number of pages12
JournalInternational Journal of Care Coordination
Volume20
Issue number4
DOIs
StatePublished - Dec 1 2017

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Home Care Services
Dementia
Delivery of Health Care
Medicare
Medicaid
Health Expenditures
Costs and Cost Analysis
Centers for Medicare and Medicaid Services (U.S.)
Aptitude
Cost Savings
Long-Term Care
Vulnerable Populations
Nursing Homes
Caregivers
Hospitalization
Research Design
Quality of Life

Keywords

  • Care coordination
  • caregivers
  • Dementia
  • Medicaid
  • Medicare
  • payment

ASJC Scopus subject areas

  • Leadership and Management
  • Health Policy

Cite this

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title = "Comprehensive home-based care coordination for vulnerable elders with dementia: Maximizing Independence at Home-Plus—Study protocol",
abstract = "Introduction: Despite availability of effective care strategies for dementia, most health care systems are not yet organized or equipped to provide comprehensive family-centered dementia care management. Maximizing Independence at Home-Plus is a promising new model of dementia care coordination being tested in the U.S. through a Health Care Innovation Award funded by the Centers for Medicare and Medicaid Services that may serve as a model to address these delivery gaps, improve outcomes, and lower costs. This report provides an overview of the Health Care Innovation Award aims, study design, and methodology. Methods: This is a prospective, quasi-experimental intervention study of 342 community-living Medicare–Medicaid dual eligibles and Medicare-only beneficiaries with dementia in Maryland. Primary analyses will assess the impact of Maximizing Independence at Home-Plus on risk of nursing home long-term care placement, hospitalization, and health care expenditures (Medicare, Medicaid) at 12, 18 (primary end point), and 24 months, compared to a propensity-matched comparison group. Discussion: The goals of the Maximizing Independence at Home-Plus model are to improve care coordination, ability to remain at home, and life quality for participants and caregivers, while reducing total costs of care for this vulnerable population. This Health Care Innovation Award project will provide timely information on the impact of Maximizing Independence at Home-Plus care coordination model on a variety of outcomes including effects on Medicaid and Medicare expenditures and service utilization. Participant characteristic data, cost savings, and program delivery costs will be analyzed to develop a risk-adjusted payment model to encourage sustainability and facilitate spread.",
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author = "Samus, {Quincy Miles} and Karen Davis and Amber Willink and Black, {Betty E} and Melissa Reuland and Leoutsakos, {Jeannie-Marie S} and Roth, {David L} and Jennifer Wolff and Gitlin, {Laura N} and Lyketsos, {Constantine G} and Johnston, {Deirdre Mary}",
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