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APHA Scientific Session and Event Listing

G. Darryl Wieland, PhD, MPH and Rebecca Boland, MA. Geriatrics Services, Palmetto Health Richland, 3010 Farrow Road, #300A, Columbia, SC 29203, 803-434-4330, darryl.wieland@palmettohealth.org

We demonstrate a case-mix adjustment approach in evaluating Medicaid outlays for PACE vs. fee-for-service [FFS] LTC. PACE provides integrated care to frail and disabled patients, pooling Medicare and Medicaid payments. While effective, PACE experiences slow growth, due in part to failure to establish its value for state payers, leading some to decline/limit participation. We classified admission mix for dual eligibles entering LTC in two South Carolina counties (PACE's market area) between 1994 and 2004. Data for PACE, community-based waiver [HCB], and NH entrants (n=3,988) were linked to Medicaid records to one-year. Inflation- and attrition-adjusted FFS costs were adjusted to reflect PACE's intermediate-risk. Comparison of PACE's Medicaid capitation to adjusted HCB and NH costs allows states to find their “breakeven” point, i.e., the proportion of PACE admissions comprised of patients who would have to be diverted from NHs (proportions of actual admissions lower than breakeven indicate higher outlays, higher proportions indicate savings). Seven profiles were developed. PACE admissions are intermediate in impairment/disability between HCB and NH entrants. SC's per capita PACE expenditure [FY05] was $27,648, vs. $13,337 (HCB) and $44,008 (NH). Forty-seven percent of PACE admissions would have to be diverted from NH for SC to “break even” in funding Medicaid LTC patients for the first year. This framework allows for comparative analysis of a state's PACE expenditures. We discuss study limitations, and extension of the general approach to PACE expansion, and the current national evaluation of PACE.

Learning Objectives:

• Describe the derviation and composition of the classification of long-term care [LTC] admissions in South Carolina.
• Articulate the construction of estimated annualized Medicaid expenditures for patient types in fee-for-service LTC.
• Discuss the method for determining whether the PACE program generates a net cost savings for the state vis-a-vis LTC alternative placements.

Keywords: Frail Elderly, Medicaid

Presenting author's disclosure statement:

Not Answered