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

Abstract #66971

Bruce Friedman, PhD¹, Gerald M. Eggert, PhD², Brenda Wamsley, MSW³, Ethan Corona, BA², Rowena Sizemore, LCSW³, and Holly C. Eggert⁴. (1) Department of Community and Preventive Medicine, University of Rochester, 601 Elmwood Avenue, Box 644, Rochester, NY 14642, (585) 273-2618, Bruce_Friedman@urmc.rochester.edu, (2) Executive Director, Monroe County Long Term Care Program, Inc./ACCESS, 349 West Commercial Street, Suite 2250, East Rochester, NY 14445, (3) Executive Director, Center for Aging & Healthcare in West Virginia, 517 Market Street, Dils Building, Parkersburg, WV 26101, (4) Duke University Medical Center, 58 Heatherhurst Drive, Pittsford, NY 14534

The Medicare Primary and Consumer-Directed Care Demonstration tested the effectiveness of three models of consumer-directed care among Medicare beneficiaries who were functionally disabled and at increased risk for high healthcare costs. Participants (N = 1605) were randomly assigned to one of four groups: (1) a Voucher for in-home services and equipment, (2) a Health Promotion Nurse (HPN) intervention, (3) the Voucher plus the HPN (the Combination group), and (4) the Control (usual care) Group. Demonstration participants completed a daily Health Care Journal including 34 specific services (all services with the exception of outpatient drugs). Here we report on the healthcare use and expenditures findings for the 1082 Demonstration participants who completed all 24 months of the intervention phase. Our hypothesis was that healthcare expenditures would be lower for each of the intervention groups than for the Control group. Excluding intervention costs, mean annual total healthcare expenditures were lower for all 3 intervention groups ($12,590 for the HPN group, $13,932 for the Voucher group, and $14,538 for the Combination group) than for the Control group ($15,166). Mean annual Medicare expenditures were lower for the HPN ($7,698) and Voucher ($7,397) groups than for the Control group ($8,120), but were higher for the Combination group ($8,514). Annual non-Medicare expenditures were lower for all 3 intervention groups ($4,892 for the HPN group, $6,535 for the Voucher group, and $6,024 for the Combination group) than for the Control group ($7,046). Annual intervention costs ranged from $1,500 to $2,500 per person per year.

Learning Objectives:

• To gain an understanding of the extent to which three models of consumer-directed care (Voucher, Health Promotion Nurse [HPN], and Voucher plus HPN) affected healthcare expenditures among functionally impaired Medicare beneficiaries at increased risk of high healthcare costs.

Keywords: Cost Issues, Interventions

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.