Mei-Chia Fong1, David Russell2,3, Carlin Brickner1, Oude Gao1, Sandi Vito4, Margaret McDonald2. 1. Business Intelligence and Analytics, Visiting Nurse Service of New York, New York, New York, USA. 2. Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, New York, USA. 3. Department of Sociology, Appalachian State University, Boone, North Carolina, USA. 4. Training and Employment Funds, 1199 Service Employees International Union, New York, New York, USA.
Abstract
OBJECTIVE: To examine the impact of a scaled implementation of workforce training intervention on value-based payment measures in a large home-based Medicaid managed long-term care plan population in New York. DATA SOURCES: Managed long-term care clients' health assessments from the Uniform Assessment System of New York merged with paid claims, home health aide operational visit data, and workforce training rosters between 2018 and early-2020. STUDY DESIGN: A quasi-experimental design was used. Exposure and control groups were constructed using the proportion of service hours delivered by trained aides between clients' baseline and follow-up/outcome assessments. Multivariate logistic generalized linear and additive models were estimated to examine associations between exposure to trained aides and value-based payment measures. DATA COLLECTION/EXTRACTION METHODS: The analytic sample consisted of 19,212 pairs of assessments from 13,320 long-term care clients continuously enrolled in the plan between baseline and follow-up/outcome assessments. Matched assessment pairs were 6-10 months apart. PRINCIPAL FINDINGS: Over 27% of the study population (n = 3656 clients) received services from one or more of 8683 trained aides. Statistically significant associations were observed for four of seven value-based payment measures; however, the presence and magnitudes of positive training effects differed by client service needs. With covariate adjustment, workforce training had the largest estimated positive impacts on rates of flu vaccination among average-need clients (1.60%, standard error [SE] = 0.01), not experiencing uncontrolled pain among above-average-need clients (0.69%, SE = 0.001), stable/improved pain intensity among heavy-need clients (1.25%, SE = 0.01), and stable/improved shortness of breath among light-need clients (0.88%, SE = 0.003). CONCLUSION: Although we found mixed associations between scaled workforce training implementation and value-based payment metrics, we noted workforce training could benefit high-need long-term care recipients. Health indicators more sensitive to the daily support provided by direct care workers should be integrated into value-based health care models.
OBJECTIVE: To examine the impact of a scaled implementation of workforce training intervention on value-based payment measures in a large home-based Medicaid managed long-term care plan population in New York. DATA SOURCES: Managed long-term care clients' health assessments from the Uniform Assessment System of New York merged with paid claims, home health aide operational visit data, and workforce training rosters between 2018 and early-2020. STUDY DESIGN: A quasi-experimental design was used. Exposure and control groups were constructed using the proportion of service hours delivered by trained aides between clients' baseline and follow-up/outcome assessments. Multivariate logistic generalized linear and additive models were estimated to examine associations between exposure to trained aides and value-based payment measures. DATA COLLECTION/EXTRACTION METHODS: The analytic sample consisted of 19,212 pairs of assessments from 13,320 long-term care clients continuously enrolled in the plan between baseline and follow-up/outcome assessments. Matched assessment pairs were 6-10 months apart. PRINCIPAL FINDINGS: Over 27% of the study population (n = 3656 clients) received services from one or more of 8683 trained aides. Statistically significant associations were observed for four of seven value-based payment measures; however, the presence and magnitudes of positive training effects differed by client service needs. With covariate adjustment, workforce training had the largest estimated positive impacts on rates of flu vaccination among average-need clients (1.60%, standard error [SE] = 0.01), not experiencing uncontrolled pain among above-average-need clients (0.69%, SE = 0.001), stable/improved pain intensity among heavy-need clients (1.25%, SE = 0.01), and stable/improved shortness of breath among light-need clients (0.88%, SE = 0.003). CONCLUSION: Although we found mixed associations between scaled workforce training implementation and value-based payment metrics, we noted workforce training could benefit high-need long-term care recipients. Health indicators more sensitive to the daily support provided by direct care workers should be integrated into value-based health care models.
Authors: Mei-Chia Fong; David Russell; Carlin Brickner; Oude Gao; Sandi Vito; Margaret McDonald Journal: Health Serv Res Date: 2022-01-10 Impact factor: 3.402
Authors: Lesley J J Soril; Laura E Leggett; Diane L Lorenzetti; Tom W Noseworthy; Fiona M Clement Journal: PLoS One Date: 2015-04-13 Impact factor: 3.240
Authors: Mei-Chia Fong; David Russell; Carlin Brickner; Oude Gao; Sandi Vito; Margaret McDonald Journal: Health Serv Res Date: 2022-01-10 Impact factor: 3.402