The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #58433

Dianne Liebel, RN MSEd¹, Deanna Lewis, MS², James Zimmer, MD³, Paul R. Katz, MD⁴, Brenda Wamsley, MSW⁵, Gerald M. Eggert, PhD⁶, Bruce Friedman, PhD³, Hongdao Meng, MPH³, and Ann Ollinger, MD⁷. (1) Monroe County Long Term Care Program, Inc./ACCESS, 349 West Commercial Street, Suite 2250, East Rochester, NY 14445, 585-248-8770, dliebel@mcltcp.org, (2) Center for Aging & Healthcare in West Virginia, Inc., 517 Market Street, Dils Center, Parkersburg, WV 26101, (3) Department of Community and Preventive Medicine, University of Rochester, 601 Elmwood Avenue, Box 644, Rochester, NY 14642, (4) Finger Lakes Geriatric Education Center, University of Rochester, Monroe Community Hospital, 435 East Henrietta Road, Rochester, NY 14620, (5) Executive Director, Center for Aging & Healthcare in West Virginia, 517 Market Street, Dils Building, Parkersburg, WV 26101, (6) Executive Director, Monroe County Long Term Care Program, Inc./ACCESS, 349 West Commercial Street, Suite 2250, East Rochester, NY 14445, (7) Monroe Community Hospital, 435 East Henrietta Road, Rochester, NY 14620

Persons with multiple chronic conditions have rapid declines in health status and great likelihood of becoming disabled and functionally impaired. Interventions that prevent functional decline have the potential not only to generate large cost savings but also to reduce the physical, emotional, social, and financial problems attributable to disability. Health promotion and disease management strategies can improve outcomes through the development of self-care management, behavior change, and skill building. This paper describes a case study investigation of high cost patients ($100,000+ in annual Medicare expenditures) in a randomized controlled trial of consumer-directed care of 1,605 frail, chronically ill Medicare beneficiaries conducted in NY, WV, and OH. The intervention endeavored to expand patient involvement in their own care through a variety of self-care and self-management approaches, including joint meetings with the physicians, participant, caregiver, and nurse (reimbursed by Medicare waivers), the use of disease management and health promotion techniques, and a strong emphasis on exercise and physical activity. This session will compare 3 high cost cases (°Ý $100,000+ annual) Medicare expenditures) to 3 low cost cases (°Ü$1,000) to illustrate risk factors associated with high use of health care services as well as protective factors associated with low health care service use. A predictive model (the 20% most costly vs. the 20% least costly) to forecast Medicare expenditures will also be presented.

Learning Objectives:

At the conclusion of the session, the participant will be able to:
• Understand Medicare high cost case studies.
• Discuss the impact of the health promotion nurse intervention on Medicare expenditures.
• Understand the components of a predictive model to prospectively identify high cost cases.

Keywords: Disease Management, Medicare

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.