Recorded presentation

Darryl Wieland, PhD¹, Tom Brown, DrPH², Brenda Wamsley, PhD³, Rebecca Boland, MA¹, Gerald M. Eggert, PhD⁴, and Joan Van Nostrand, DPA⁵. (1) Division of Geriatrics, School of Medicine, University of South Carolina, Nine Medical Park, #630, Columbia, SC 29203, 803-434-4330, Darryl.Wieland@palmettohealth.org, (2) Health Services Research, Palmetto Health, 111 Doctor's Circle, Columbia, SC 29203, (3) Executive Director, Center for Aging & Healthcare in West Virginia, 517 Market Street, Dils Building, Parkersburg, WV 26101, (4) Executive Director, Monroe County Long Term Care Program, Inc./ACCESS, PO Box 429, East Rochester, NY 14445, (5) Director of Research, Office of Rural Health Policy, HRSA, 5600 Fishers Lane, Rm 9A-55, Rockville, MD 20857

We developed a case typology based on clients’ assessed diseases, impairments, psychosocial characteristics, and disabilities, in order to set an annually adjustable Medicare rate for a waivered program of primary and consumer-directed care in rural areas of New York (ACCESS), and West Virginia and Ohio (Connect Care). The population was comprised of elderly and disabled community residents who were Medicare parts A & B eligible, moderately-to-severely physically or cognitively impaired, and prior high-volume users of Medicare services (n=1,605). The dataset comprised comprehensive assessment variables at admission for all clients during the program’s demonstration phase. Grade-of-membership [GoM] analysis was used to determine disease-impairment-disability types. The typology was validated against clients’ demographic characteristics and subsequent attrition information and resource utilization. Medicare and total chronic care rates were developed to account for interstate variations in case mix and retention probabilities, FY2003 prices and service use patterns. Ten profiles identified variation in disease burden, impairments, and disabilities. The third most prevalent profile (10.3%) represents the younger adult (age < 55) disabled. Nine are grouped into elderly cognitively intact and cognitively impaired series, varying in prevalence by state. Content and predictive validity are demonstrated. Total annual estimated payments ranged from $15,381 in WV, to $20,687 in NY. Medicare payment estimates ranged from $10,956 in WV, to $13,573 in OH. GoM classification produced a clinically valid, annually adjustable basis for Medicare rate setting for the ACCESS and Connect Care programs. With annual updating of costs and utilization, Medicare rates can be kept current.

Learning Objectives: Attendees will

• acquire a basic understanding of the ACCESS/Cennect Care demonstrations;
• understand the application of grade-of-membership methods to the development and validation of a disease-impairment-disability typology of rural elderly and disabled program participants; and 3)appreciate the application of GoM classification to Medicare rate-setting.

Keywords: Medicare, Rural Health Care

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Recorded presentation