Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #110411

Bruce Friedman, PhD, 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, Hongdao Meng, PhD, Department of Preventive Medicine, Stony Brook University, HSC, Level 3, Rm071, Stony Brook University, Stony Brook, NY 11794-8338, Brenda R. Wamsley, PhD, Executive Director, Center for Aging & Healthcare in West Virginia, 517 Market Street, Dils Building, Parkersburg, WV 26101, and Gerald Eggert, PhD, Executive Director, Monroe County Long Term Care Program, Inc, P.O. Box 429, East Rochester, NY 14445.

The Medicare Primary and Consumer-Directed Care Demonstration was a randomized controlled trial that tested the effectiveness of two models of consumer-directed care, a chronic disease self-management/health promotion Nurse intervention and a Voucher, plus their Combination, among Medicare beneficiaries who were functionally disabled and at increased risk for high healthcare costs.

Methods: Here we compare mean Medicare, non-Medicare, and total healthcare expenditures of the 451 rural (non-Metropolitan Statistical Area) participants who were cognitively intact (Cognitive Performance Scale [CPS] score < 2) (n=336) versus those who were cognitively impaired (CPS>1) (n=115).

Results: Including intervention costs, mean monthly total healthcare expenditures for the cognitively intact participants were extremely similar per patient per month for the Control, Voucher, and Combination groups ($1511, $1543, and $1512, respectively) and were slightly higher for the Nurse group ($1648). However, for the cognitively impaired they were considerably lower for each of the intervention groups ($1654, $1529, and $1867 for the Voucher, Nurse, and Combination groups, respectively) as compared to the control group ($2189). Medicare expenditures were 49%, 42%, and 34% lower for the Voucher, Combination, and Nurse groups as compared to the Control group. For non-Medicare expenditures they were 23% lower for the Nurse group but were 25% higher for the Voucher group and 39% higher for the Combination group than for the Control group.

Conclusion: While none of the 3 interventions reduced mean total healthcare expenditures among cognitively intact rural patients, all 3 reduced total healthcare expenditures and Medicare expenditures for cognitively impaired rural patients.

Learning Objectives:

• The participants in the session will acquire information about how healthcare expenditures of rural patients in the Medicare Primary and Consumer-Directed Care Demonstration differed between cognitively intact and cognitively impaired patients.
• The participants in the session will be able to identify and describe how healthcare expenditures differed across the several interventions in the Demonstration for the cognitively intact and the cognitively impaired.

Keywords: Medicare, Rural Health Care

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.