Bruce Friedman, PhD¹, Hongdao Meng, MS¹, Brenda R. Wamsley, PhD², and Gerald M. Eggert, PhD³. (1) Department of Community and Preventive Medicine, University of Rochester, 601 Elmwood Avenue, Box 644, Rochester, NY 14642, (585) 273-2618, Bruce_Friedman@urmc.rochester.edu, (2) Executive Director, Center for Aging & Healthcare in West Virginia, 517 Market Street, Dils Building, Parkersburg, WV 26101, (3) Executive Director, Monroe County Long Term Care Program, Inc./ACCESS, PO Box 429, East Rochester, NY 14445

Little research has been conducted on the impact of primary care-affiliated health promotion/chronic disease self-management or consumer-directed vouchers on healthcare expenditures of functionally impaired, community-dwelling Medicare beneficiaries who live in rural areas.

Methods: The CMS Medicare Primary and Consumer-Directed Care Demonstration was a randomized controlled trial with four groups: health promotion/disease management Nurse, Voucher, Combination (Nurse plus Voucher), and Control. 451 participants resided in 13 non-MSA counties in NY, WV, and OH. Regression analyses of logged healthcare expenditures were estimated, including baseline sociodemographic and health status variables as covariates.

Results: Adjusted total healthcare costs (including intervention costs) did not differ significantly between the Nurse ($28,694) and Control ($28,710) groups but were significantly higher for both the Voucher ($31,450) and Combination ($32,816) groups. For the participants who completed the 24 months of the Demonstration, adjusted total costs were significantly lower for the Nurse group ($28,617) than the Control group ($30,021) but were significantly higher for the Voucher ($30,337) and Combination ($33,635) groups. For decedents, adjusted total costs were significantly higher for the Nurse ($45,179) and Voucher ($38,861) groups than for the Control group ($32,710). When patients with a heart condition and 2+ ADLs were analyzed separately because they were more appropriate for a palliative care program, adjusted total costs were significantly lower for the Nurse group ($22,013) than the Control group ($25,925).

Conclusion: While the Voucher resulted in significantly higher total expenditures, the Nurse intervention broke even for total expenditures and resulted in cost savings for those who completed 24 months.

Learning Objectives: At the conclusion of the session, the participant in this session will be able to

• Understand how 3 innovative healthcare models affected healthcare expenditures of functionally impaired Medicare beneficiaries in rural areas.
• Understand how 3 innovative healthcare models affected healthcare expenditures of functionally impaired Medicare beneficiaries in rural areas who completed the entire 24 months of the demonstration.
• Understand how 3 innovative healthcare models affected healthcare expenditures of functionally impaired Medicare beneficiaries in rural areas who died during the demonstration.
• Understand how 3 innovative healthcare models affected healthcare expenditures of functionally impaired Medicare beneficiaries in rural areas who had a heart condition and 2+ ADLs.

Keywords: Consumer Direction, Rural Health Care

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Centers for Medicare and Medicaid Services; Office of Rural Health Policy, Health Resources and Services Administration
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.