Measuring the Relationship Between HCBS and Health. Health Care Utilization and Expenditures

Transcription

1 Measuring the Relationship Between HCBS and Health Amanda Reichard, PhD Martha Hodgesmith, JD Hayley Stolzle, MPH Michael Fox, ScD Thursday, October 28, 2010 Outline Context Methods Results Health Care Utilization and Expenditures Pre vs. Post Enrollment in HCBS vs. Groups Participation Survey Discussion 1

2 N = 72,859 in Medicaid ABD (FY2008) N =13,541 N = 10,043 N = 24,583 N = 12,684 N =12,008 IDD PD SPMI Aged NEC 18.6% 13.8% 33.7% 17.4% 16.5% Diagnosis Codes HCBS CDPS N = % Shireman & Reichard, 2010 Relationship of PAS (through HCBS) and Health HCBS = Coverage for PAS Minimize loss of function Impacts health status and ability to participate in the community ***HCBS waivers enable people with various disabilities and substantial longterm care needs to remain in the community. *** 2

3 PD Waiver Demographics Descriptive Variables Total Sample Percent N = 9025 Gender Female 65.6 Male 34.4 Age Mean 53.0 Race White 79.2 Black 17.9 Other 2.9 Dual Eligibility 51.0 Rural

4 Methods Retrospective cohort analysis of KS Medicaid claims Pre Enrollment Period= 6 months before enrolling in HCBS Post Enrollment Period= months 7-12 after HCBS enrollment (Ultimately we will compare data for one year after enrollment) Methods Sample: Group: people who lived in community when they enrolled in HCBS Group: people who lived in nursing facility 6 months before immediately before they enrolled in HCBS Matched on ratio 1:5 on age, gender, geography Enrolled in HCBS in FY06 or FY07 4

5 RESULTS Demographics Descriptive Variables Gender Age Total Sample N = 313 N = 54 N = 367 Female 68.1% 61.1 % 67.0% Male 31.9% 38.9% 33.0% Mean 51.9 (95% C.I., ) 52.2 (95% C.I., ) 52.0 (95% C.I., ) % 1.9% 2.7% % 64.8% 60.2% % 31.5% 35.7% % 1.9% 1.4% Note: There were no significant group differences (p<.05) (χ2) in demographics between the community and nursing home groups. C.I. = Confidence Interval 5

6 Demographics (Cont.) Descriptive Variables Race Total Sample N = 313 N = 54 N = 367 White 75.4% 88.9% 77.4% Black 22.0% 11.1% 20.4% Other 2.6% 0.0% 2.2% Dual Eligibility 50.5% 53.7% 51.0% Rural 71.6% 79.6% 72.8% Note: There were no significant group differences (p<.05) (χ2) in demographics between the community and nursing home groups Comorbidity Among HCBS PD Waiver Recipients * p <.05 6

7 * p <.05 * * * Total Cost For Health Care Services: Pre vs. Post Enrollment $4,000,000 $3,500,000 $3,000,000 $2,500,000 $2,000,000 $1,500,000 $1,000,000 Pharmacy Outpatient Inpatient $500,000 $0 Pre-Enrollment Post-Enrollment 7

8 Inpatient Summary: Pre/Post Pre Enrollment Post Enrollment People admitted N = 116 N = 87 Admits Mean Cost/Person $17,632 $5,759 Analysis of inpatient care demonstrates much improvement as a result of enrolling in HCBS (to receive PAS). Outpatient Summary: Pre/Post Pre Enrollment Post Enrollment Unique Benes 90.0% 97.0% Visits Per Bene Mean Cost/Bene $3,241 $2,644 8

9 Pharmacy Summary: Pre/Post Pre Enrollment Post Enrollment Unique Benes 69.0% 78.0% Scripts Per Person/Mo Mean Cost/Person $2,203 $3,181 *p <.05 9

10 *p <.05 vs. NH Group Summary NH group had significantly more comorbidities (11.4 vs. 9.8 on average) NH group had higher needs in the community than the group (based on PAS and Home Health use) 10

11 vs. NH Group Summary Cost/Person Use/Person Inpatient NH Out Patient ~Equal Pharmacy NH HCBS NH NH Participation Survey Modified version of CDPAS and SPARC (Dr. Gray and Dr. Dashner) Purpose: To examine the relationship between PAS, community participation and health N = 58 11

12 Demographics Descriptive Variables Percent (95% C.I.) N = 37 Percent (95% C.I.) N = 21 Total Sample Percent (95% C.I.) N = 58 Gender Female Male Age Mean ( ) ( ) ( ) Race White Black Dual Eligibility Rural Mean Total Costs 12

13 % of sample % of sample 11/05/ Self-Reported Health Status* % 45.9% % 30% % 10% 5% 2.7% Poor Fair Good Very good *p < Importance of Having Paid PAS at Home % % % 10.5% Very Unimportant 21.1% 5.3% 0% 2.9% Unimportant Important Very Important 13

14 % of sample % of sample 11/05/ Amount of Choice Regarding Paid PAS at Home % % % 21.1% 14.3% 5.7% 0% 2.9% No choice Little choice Some choice A lot of choice 100 Level of Satisfaction with Paid PAS % 68.4% % % 0 3% 0% Dissatisfied Satisfied Very satisfied 14

15 % of sample % of sample 11/05/ Importance of Leaving Home and Doing Activities % 50.0% % % 20.0% 8.1% 10.0% 5.4% 0.0 Very Unimportant Important Very Unimportant Important 100 Ability to Leave Home on Own % 66.7% % 28.6% % 4.8% Never leave home Leave home on own Direct others to help leave home 15

16 % of sample % of sample 11/05/ Leaving Home Limitations by Pain* % 45.9% % % 18.9% 15.0% 21.6% 5.0% 0 * p <.05 None A little A moderate amount A great deal 100 Leaving Home Limitations by Fatigue % 25.0% 18.9% 30.0% 35.1% 32.4% 40.0% 5.0% 0 None A little A moderate amount A great deal 16

17 Summary and Discussion Getting HCBS, getting healthy and participating Managing to better health through transition Next steps 17