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
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 = 9029 89.9% 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
PD Waiver Demographics Descriptive Variables Total Sample Percent N = 9025 Gender Female 65.6 Male 34.4 Age Mean 53.0 Race 18-34 7.2 35-54 44.3 55-64 34.2 65+ 14.3 White 79.2 Black 17.9 Other 2.9 Dual Eligibility 51.0 Rural 56.4 3
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
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., 51.05-52.75) 52.2 (95% C.I., 50.23-54.21) 52.0 (95% C.I., 51.22-52.78) 18-34 2.9% 1.9% 2.7% 35-54 59.4% 64.8% 60.2% 55-64 36.4% 31.5% 35.7% 65+ 1.3% 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
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. 90.0 80.0 70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 Comorbidity Among HCBS PD Waiver Recipients * p <.05 6
* 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
Inpatient Summary: Pre/Post Pre Enrollment Post Enrollment People admitted N = 116 N = 87 Admits 258 162 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 69.7 66.0 Mean Cost/Bene $3,241 $2,644 8
Pharmacy Summary: Pre/Post Pre Enrollment Post Enrollment Unique Benes 69.0% 78.0% Scripts Per Person/Mo. 10.0 8.3 Mean Cost/Person $2,203 $3,181 *p <.05 9
*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
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
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 74.7 61.9 70.7 Male 24.3 38.1 29.3 Age Mean 51.78 (54.49-49.07) 57.86 (60.41-55.31) 53.73 (51.77-55.69) Race 18-34 5.4 0.0 3.4 35-54 67.6 42.9 58.6 55-64 24.3 57.1 36.2 65+ 2.7 0.0 1.7 White 83.8 90.5 86.2 Black 16.2 9.5 13.8 Dual Eligibility 43.2 33.3 39.7 Rural 70.3 85.7 75.9 Mean Total Costs 12
% of sample % of sample 11/05/2010 100 Self-Reported Health Status* 80 60 55% 45.9% 40 37.8% 30% 20 0 13.5% 10% 5% 2.7% Poor Fair Good Very good *p <.05 100 Importance of Having Paid PAS at Home 80 79.4% 60 63.2% 40 20 0 17.6% 10.5% Very Unimportant 21.1% 5.3% 0% 2.9% Unimportant Important Very Important 13
% of sample % of sample 11/05/2010 100 Amount of Choice Regarding Paid PAS at Home 80 77.1% 60 57.9% 40 20 0 21.1% 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 80 60 78.8% 68.4% 40 31.6% 20 18.2% 0 3% 0% Dissatisfied Satisfied Very satisfied 14
% of sample % of sample 11/05/2010 100.0 Importance of Leaving Home and Doing Activities 80.0 60.0 59.5% 50.0% 40.0 27.0% 20.0 20.0% 20.0% 8.1% 10.0% 5.4% 0.0 Very Unimportant Important Very Unimportant Important 100 Ability to Leave Home on Own 80 64.9% 66.7% 60 40 35.1% 28.6% 20 0 0% 4.8% Never leave home Leave home on own Direct others to help leave home 15
% of sample % of sample 11/05/2010 100 Leaving Home Limitations by Pain* 80 60 50.0% 45.9% 40 30.0% 20 13.5% 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 80 60 40 20 13.5% 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
Summary and Discussion Getting HCBS, getting healthy and participating Managing to better health through transition Next steps 17