200666 Economic implications of providing home based care in rural settings

Tuesday, November 10, 2009: 5:00 PM

Steven Szebenyi, MD, MMM , Foundation For Healthy Living, Latham, NY
Rebecca Van vorst, MSPH , Foundation For Healthy Living, Latham, NY
Keyur Thaker, MD , School of Public Health, Univeristy at Albany, Rensselaer, NY
Diane Dewar, PhD , Health Policy, Management and Behavior, University at Albany, State University of New York, Rensselaer, NY
Context: Home visits to older people can improve care, reduce utilization and cut costs under Medicare risk. However, providing home care visits is more costly than conducting appointments in a physician's office. Hudson Headwaters Health Network (HHHN), a federally qualified health center in rural, Upstate New York, began a new program to provide home based care to frail elderly living in the community, but the long term cost-effectiveness of this program is unknown.

Study Objectives: To determine the cost savings of providing preventive and interventional home care to rural frail elderly.

Study Design: Randomized case/control.

Setting: HHHN practices that are part of the Capital-Adirondack Practice Based Research Network.

Participants: 174 adults aged 64 or older who scored at-risk for functional decline as measured by the VES-13.

Study Intervention: Provision of home based primary care

Outcome Measures: Pre/post intervention measures of utilization and costs from a Medicare managed care insurer.

Results: The odds of inpatient admissions, outpatient admissions and pharmacy claims are significantly less for the intervention group than the control group. Males had lesser odds of having a pharmacy claim compared to females, but males in the intervention group were more likely to have a pharmacy claim. Patients over 80 years are less likely to have a pharmacy claim compared to people less than 80 years.

Conclusions: These results imply that the intervention is cost reducing, since utilization of many higher cost services are likely to be decreased for the home based care.

Learning Objectives:
Evaluate the benefits of home based care for rural elderly Identify areas for cost savings for the home based care group

Keywords: Elderly, Rural Health Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have a book in press on health economics, and have been involved in a research grant from Langloth Foundation concerning this paper.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

See more of: Rural Aging Issues
See more of: Gerontological Health