Sarah L Szanton1,2, Y Natalia Alfonso2, Bruce Leff1,3, Jack Guralnik4, Jennifer L Wolff2, Ian Stockwell5, Laura N Gitlin1,3, David Bishai2. 1. School of Nursing, Johns Hopkins University, Baltimore, Maryland. 2. Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland. 3. School of Medicine, Johns Hopkins University, Baltimore, Maryland. 4. School of Medicine, University of Maryland, Baltimore, Maryland. 5. Hilltop Institute, University of Maryland Baltimore County, Baltimore, Maryland.
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.
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.
Authors: Jennifer L Wolff; Lauren H Nicholas; Amber Willink; John Mulcahy; Karen Davis; Judith D Kasper Journal: Ann Intern Med Date: 2019-05-28 Impact factor: 25.391
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