Medicaid Cost Savings of a Preventive Home Visit Program for Disabled Older Adults

Research output: Contribution to journalArticle

Abstract

Background/Objectives: Little is known about cost savings of programs that reduce disability in older adults. The objective was to determine whether the Community Aging in Place, Advancing Better Living for Elders (CAPABLE) program saves Medicaid more money than it costs to provide. Design: Single-arm clinical trial (N = 204) with a comparison group of individuals (N = 2,013) dually eligible for Medicaid and Medicare matched on baseline geographic and demographic characteristics, chronic conditions, and healthcare use. We used finite mixture model regression estimates in a Markov model. Setting: Baltimore, MD Participants: Individuals aged 65 and older with reported difficulty with at least one activity of daily living. Intervention: CAPABLE is a 5-month program to reduce the health effects of impaired physical function in low-income older adults by addressing individual capacity and the home environment. CAPABLE uses an interprofessional team (occupational therapist, registered nurse, handyman) to help older adults attain self-identified functional goals. Measurements: Monthly average Medicaid expenditure and likelihood of high- or low-cost use of eight healthcare service categories. Results: Average Medicaid spending per CAPABLE participant was $867 less per month than that of their matched comparison counterparts (observation period average 17 months, range 1-31 months). The largest differential reduction in expenditures were for inpatient care and long-term services and supports. Conclusion: CAPABLE is associated with lower likelihood of inpatient and long-term service use and lower overall Medicaid spending. The magnitude of reduced Medicaid spending could pay for CAPABLE delivery and provide further Medicaid program savings due to averted services use. Clinical trial registration: CAPABLE for Frail dually eligible older adults NCT01743495 https://clinicaltrials.gov/ct2/show/NCT01743495

Original languageEnglish (US)
JournalJournal of the American Geriatrics Society
DOIs
StateAccepted/In press - Jan 1 2017

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Independent Living
House Calls
Cost Savings
Medicaid
Health Expenditures
Costs and Cost Analysis
Inpatients
Clinical Trials
Delivery of Health Care
Frail Elderly
Baltimore
Long-Term Care
Activities of Daily Living
Medicare
Nurses
Observation
Demography
Health

Keywords

  • Health disparities
  • Medicaid costs
  • Physical function and costs

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

@article{10423c1874044547987de12278229103,
title = "Medicaid Cost Savings of a Preventive Home Visit Program for Disabled Older Adults",
abstract = "Background/Objectives: Little is known about cost savings of programs that reduce disability in older adults. The objective was to determine whether the Community Aging in Place, Advancing Better Living for Elders (CAPABLE) program saves Medicaid more money than it costs to provide. Design: Single-arm clinical trial (N = 204) with a comparison group of individuals (N = 2,013) dually eligible for Medicaid and Medicare matched on baseline geographic and demographic characteristics, chronic conditions, and healthcare use. We used finite mixture model regression estimates in a Markov model. Setting: Baltimore, MD Participants: Individuals aged 65 and older with reported difficulty with at least one activity of daily living. Intervention: CAPABLE is a 5-month program to reduce the health effects of impaired physical function in low-income older adults by addressing individual capacity and the home environment. CAPABLE uses an interprofessional team (occupational therapist, registered nurse, handyman) to help older adults attain self-identified functional goals. Measurements: Monthly average Medicaid expenditure and likelihood of high- or low-cost use of eight healthcare service categories. Results: Average Medicaid spending per CAPABLE participant was $867 less per month than that of their matched comparison counterparts (observation period average 17 months, range 1-31 months). The largest differential reduction in expenditures were for inpatient care and long-term services and supports. Conclusion: CAPABLE is associated with lower likelihood of inpatient and long-term service use and lower overall Medicaid spending. The magnitude of reduced Medicaid spending could pay for CAPABLE delivery and provide further Medicaid program savings due to averted services use. Clinical trial registration: CAPABLE for Frail dually eligible older adults NCT01743495 https://clinicaltrials.gov/ct2/show/NCT01743495",
keywords = "Health disparities, Medicaid costs, Physical function and costs",
author = "Szanton, {Sarah L} and Alfonso, {Yira Natalia} and Leff, {Bruce A} and Jack Guralnik and Jennifer Wolff and Ian Stockwell and Gitlin, {Laura N} and Bishai, {David M}",
year = "2017",
month = "1",
day = "1",
doi = "10.1111/jgs.15143",
language = "English (US)",
journal = "Journal of the American Geriatrics Society",
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TY - JOUR

T1 - Medicaid Cost Savings of a Preventive Home Visit Program for Disabled Older Adults

AU - Szanton, Sarah L

AU - Alfonso, Yira Natalia

AU - Leff, Bruce A

AU - Guralnik, Jack

AU - Wolff, Jennifer

AU - Stockwell, Ian

AU - Gitlin, Laura N

AU - Bishai, David M

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Background/Objectives: Little is known about cost savings of programs that reduce disability in older adults. The objective was to determine whether the Community Aging in Place, Advancing Better Living for Elders (CAPABLE) program saves Medicaid more money than it costs to provide. Design: Single-arm clinical trial (N = 204) with a comparison group of individuals (N = 2,013) dually eligible for Medicaid and Medicare matched on baseline geographic and demographic characteristics, chronic conditions, and healthcare use. We used finite mixture model regression estimates in a Markov model. Setting: Baltimore, MD Participants: Individuals aged 65 and older with reported difficulty with at least one activity of daily living. Intervention: CAPABLE is a 5-month program to reduce the health effects of impaired physical function in low-income older adults by addressing individual capacity and the home environment. CAPABLE uses an interprofessional team (occupational therapist, registered nurse, handyman) to help older adults attain self-identified functional goals. Measurements: Monthly average Medicaid expenditure and likelihood of high- or low-cost use of eight healthcare service categories. Results: Average Medicaid spending per CAPABLE participant was $867 less per month than that of their matched comparison counterparts (observation period average 17 months, range 1-31 months). The largest differential reduction in expenditures were for inpatient care and long-term services and supports. Conclusion: CAPABLE is associated with lower likelihood of inpatient and long-term service use and lower overall Medicaid spending. The magnitude of reduced Medicaid spending could pay for CAPABLE delivery and provide further Medicaid program savings due to averted services use. Clinical trial registration: CAPABLE for Frail dually eligible older adults NCT01743495 https://clinicaltrials.gov/ct2/show/NCT01743495

AB - Background/Objectives: Little is known about cost savings of programs that reduce disability in older adults. The objective was to determine whether the Community Aging in Place, Advancing Better Living for Elders (CAPABLE) program saves Medicaid more money than it costs to provide. Design: Single-arm clinical trial (N = 204) with a comparison group of individuals (N = 2,013) dually eligible for Medicaid and Medicare matched on baseline geographic and demographic characteristics, chronic conditions, and healthcare use. We used finite mixture model regression estimates in a Markov model. Setting: Baltimore, MD Participants: Individuals aged 65 and older with reported difficulty with at least one activity of daily living. Intervention: CAPABLE is a 5-month program to reduce the health effects of impaired physical function in low-income older adults by addressing individual capacity and the home environment. CAPABLE uses an interprofessional team (occupational therapist, registered nurse, handyman) to help older adults attain self-identified functional goals. Measurements: Monthly average Medicaid expenditure and likelihood of high- or low-cost use of eight healthcare service categories. Results: Average Medicaid spending per CAPABLE participant was $867 less per month than that of their matched comparison counterparts (observation period average 17 months, range 1-31 months). The largest differential reduction in expenditures were for inpatient care and long-term services and supports. Conclusion: CAPABLE is associated with lower likelihood of inpatient and long-term service use and lower overall Medicaid spending. The magnitude of reduced Medicaid spending could pay for CAPABLE delivery and provide further Medicaid program savings due to averted services use. Clinical trial registration: CAPABLE for Frail dually eligible older adults NCT01743495 https://clinicaltrials.gov/ct2/show/NCT01743495

KW - Health disparities

KW - Medicaid costs

KW - Physical function and costs

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DO - 10.1111/jgs.15143

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JO - Journal of the American Geriatrics Society

JF - Journal of the American Geriatrics Society

SN - 0002-8614

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