Reimbursement for rehabilitation services for older individuals who are blind: Improving cost-effectiveness and satisfaction

The rehabilitation system for individuals who are blind or visually impaired is directed towards goal achievement and directed towards acquisition of skills to permit useful and functional lives and entry into the job market or return to work. The majority of people with vision loss are elderly and older adults have needs that continuously evolve into other needs, often more complex and costly; however, traditionally, individuals are discharged upon completion of their plan of care. Previously, (APHA 2005) we reported on the initiation of a 4-year demonstration project sponsored by New York State and designed to provide continuous service availability with capitated provider reimbursement that seamlessly integrates vision care and rehabilitation into a delivery model to address the needs of older blind individuals as they present and as they evolve. From 2005-2008, 816 individuals who applied for state-sponsored rehabilitation services were randomly assigned to experimental and control groups. The control group received services authorized under their plan of care, while those assigned to the experimental group received the same types of service in addition to monthly case management contacts, referral for services not included in plan of care including additional healthcare and rehabilitation services necessary to enable them to remain independent. Control group cases were generally closed within one year while experimental group cases remained active for the duration of the project since part of the experimental model was to evaluate the effectiveness of on-going case management activity. This presentation will discuss the results and policy implications of this study.