Quality Impact of Geriatric Care Management: An Evaluation with a Medicare Advantage Population

BACKGROUND: Utilization of medical services increases dramatically with age for a variety of reasons; an important consideration for this may be the preponderance of multiple concurrent chronic conditions and psychosocial barriers to care. In the Medicare 5% sample data of 2001, beneficiaries with five or more chronic conditions account for two-thirds of Medicare spending; 10% of the beneficiaries accounted for 81% of inpatient utilization and 51% of total health care utilization. Managing such complex cases is critical to impacting quality and utilization.

METHODS: Review of medical utilization pre and post implementation of geriatric care management program; historic comparisons and comparisons with Fee for Service (FFS) Medicare in the same region.

RESULTS: Aetna's Geriatric Care Management program was implemented in 2003. At the end of 2005, 16% had been enrolled into geriatric care management. Comparing Aetna's 2005 utilization data from regions with Aetna Medicare Advantage membership with Medicare FFS 2003 data for the corresponding regions, this membership had 35% less acute inpatient bed days per thousand and 40% less subacute bed days per thousand. Additionally, the denial rate for length of stay for these regions was only 4%.

Aetna's 2006 HEDIS Measures also improved from 2003 to 2005. Controlling high blood pressure went from 60% to 69%, beta blocker treatment after heart attack went from 94% to 97%, and pneumonia vaccinations for the elderly went from 65% to 70%.

CONCLUSION: Geriatric Care Management has a favorable impact on the quality of care and improving medical utilization outcomes for Medicare HMO members.