Making It Safe to Grow Old: A Financial Simulation Model for Launching MediCaring Communities for Frail Elderly Medicare Beneficiaries

Milbank Quarterly

Volumn 94, Issue 3, 2016, Pages 597-625

  Bernhardt, Antonia K ^a,b   Lynn, Joanne ^b   Berger, Gregory ^c,d   Lee, James A ^b   Reuter, Kevin ^d   Davanzo, Joan ^d   Montgomery, Anne ^b   Dobson, Allen ^d  

^a Avalere Health   (United States)

^b ALTARUM INSTITUTE   (United States)

^c America's Health Insurance Plans   (United States)

^d Dobson DaVanzo Associates   (United States)

Author keywords

financing; frail elderly; long term care; Medicare

Indexed keywords

ADL DISABILITY; ARTICLE; COMMUNITY PROGRAM; COST CONTROL; FRAIL ELDERLY; HEALTH CARE DELIVERY; HEALTH CARE FINANCING; HEALTH CARE UTILIZATION; HOME CARE; HOSPITALIZATION; LONG TERM CARE; MEDICAID; MEDICARE; NURSING HOME; PRIORITY JOURNAL; SIMULATION; UNITED STATES;

EID: 84987749252     PISSN: 0887378X     EISSN: 14680009     Source Type: Journal    
DOI: 10.1111/1468-0009.12199     Document Type: Article

References (54)

1. Favreault M, Dey J. Long-term Services and Supports for Older Americans: Risks and Financing Research Brief. Washington, DC: Assistant Secretary for Planning and Evaluation; 2015. https://aspe.hhs.gov/basic-report/long-term-services-and-supports-older-americans-risks-and-financing-research-brief. Accessed May 25, 2016.
2. US Census Bureau. Statistical Abstract of the United States: 2003, Table No. HS-16. Expectation of Life at Birth by Race and Sex: 1900 to 2001. Washington, DC: US Census Bureau; 2003.
3. Jones DS, Podolsky SH, Greene JA. The burden of disease and the changing task of medicine. N Engl J Med. 2012;366(25):2333-2338.
4. Neuman MD, Bosk CL. The redefinition of aging in American surgery. Milbank Q. 2013;91(2):288-315.
5. Plassman B, Langa K, Fisher G, et al. Prevalence of dementia in the United States: the Aging, Demographics, and Memory Study. Neuroepidemiology. 2007;29(1-2):125-132.
6. Hebert LE, Weuve J, Scherr PA, Evans DA. Alzheimer disease in the United States (2010-2050) estimated using the 2010 census. Neurology. 2013;80(19):1778-1783.
7. Alemayehu B, Warner KE. The lifetime distribution of health care costs. Health Serv Res. 2004;39(3):627-642.
8. Dartmouth Atlas of Health Care. Total Medicare Reimbursements per Decedent, by Interval Before Death. Hanover, NH: Dartmouth Institute for Health Policy and Clinical Practice; 2015. http://www.dartmouthatlas.org/data/table.aspx?ind=23&loct=3&tf=20&fmt=45&ch=1. Accessed May 25, 2016.
9. Webb A, Zhivan NA. How much is enough? The distribution of lifetime health care costs. Working Paper. WP#2010-1. Chestnut Hill, MA: Center for Retirement Research; 2010.
10. Curtis LH, Ostbye T, Sendersky V, et al. Inappropriate prescribing for elderly Americans in a large outpatient population. Arch Intern Med. 2004;164(15):1621-1625.
11. Inouye SK. Delirium in older persons. N Engl J Med. 2006;354(11):1157-1165.
12. Thomas KS, Mor V. Providing more home-delivered meals is one way to keep older adults with low care needs out of nursing homes. Health Aff (Millwood). 2013;32(10):1796-1802.
13. Ortman JM, Velkoff VA, Hogan H. An Aging Nation: The Older Population in the United States. Washington, DC: US Census Bureau; 2014.
14. Redfoot D, Feinberg LF, Houser A. The Aging of the Baby Boom and the Growing Care Gap: A Look at Future Declines in the Availability of Family Caregivers. Washington, DC: AARP Public Policy Institute; 2013. http://www.aarp.org/home-family/caregiving/info-08-2013/the-aging-of-the-baby-boom-and-the-growing-care-gap-AARP-ppi-ltc.html. Accessed May 25, 2016.
15. Institute of Medicine. Retooling for an Aging America: Building the Health Care Workforce. Washington, DC: Institute of Medicine; 2008. http://www.nap.edu/catalog/12089/retooling-for-an-aging-america-building-the-health-care-workforce. Accessed May 25, 2016.
16. Counsell SR, Callahan CM, Tu W, Stump TE, Arling GW. Cost analysis of the Geriatric Resources for Assessment and Care of Elders care management intervention. J Am Geriatr Soc. 2009;57(8):1420-1426.
17. Centers for Medicare and Medicaid Services. Financial Alignment Initiative. Baltimore, MD: Centers for Medicare and Medicaid Services; 2015. http://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/FinancialAlignmentInitiative/FinancialModelstoSupportStatesEffortsinCareCoordination.html. Accessed March 17, 2015.
18. Wieland D, Kinosian B, Stallard E, Boland R. Does Medicaid pay more to a Program of All-Inclusive Care for the Elderly (PACE) than for fee-for-service long-term care? J Gerontol A Biol Sci Med Sci. 2013;68(1):47-55.
19. Gawande A. Being Mortal: Medicine and What Matters in the End. New York, NY: Metropolitan Books; 2014.
20. Lynn J. Reliable and sustainable comprehensive care for frail elderly people. JAMA. 2013;310(18):1935-1936.
21. Lynn J, Montgomery A. The MediCaring model: best plan for frail elders in the longevity era. Public Policy and Aging Report. 2014;24:112-117.
22. Lynn J, Montgomery A. Creating a comprehensive care system for frail elders in “age boom” America. Gerontologist. 2015;5(2):278-285.
23. Edes T, Kinosian B, Vuckovic NH, Nichols LO, Becker MM, Hossain M. Better access, quality, and cost for clinically complex veterans with home-based primary care. J Am Geriatr Soc. 2014;62(10):1954-1961.
24. De Jonge EK, Jamshed N, Gilden D, Kubisiak J, Bruce SR, Taler G. Effects of home-based primary care on Medicare costs in high-risk elders. J Am Geriatr Soc. 2014;62(10):1825-1831.
25. Center for Medicare and Medicaid Innovation. Financial Plan Template. Baltimore, MD: Centers for Medicare and Medicaid Services; 2013.
26. US Census Bureau. 2010 Census Data Demographic Profile Summary Files. Washington, DC: US Census Bureau; 2011.
27. Singer AE, Meeker D, Teno J, Lynn J, Lunney JR, Lorenz KA. Symptom trends in the last year of life from 1998 to 2010. Ann Intern Med. 2014;162(3):175-188.
28. Wan H, Muenchrath M. 90+ in the United States: 2006-2008. American Community Survey Reports. ACS-17. Washington, DC: US Census Bureau; 2011. http://www.census.gov/prod/2011pubs/acs-17.pdf. Accessed August 20, 2014.
29. Xue Q-L. The frailty syndrome: definition and natural history. Clin Geriatr Med. 2011;27(1):1-15.
30. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146-156.
31. National Center for Health Statistics. Compressed Mortality File 1999-2010. Vol 20. CDC WONDER Online Database. Washington, DC: Centers for Disease Control and Prevention; January 2013.
32. Aguiar C. Coordinating Care for Dual-Eligible Beneficiaries Through the PACE Program. Washington, DC: Medicare Payment Advisory Commission; 2011.
33. US Census Bureau. Annual Estimates of the Resident Population for Selected Age Groups by Sex for the United States, States, Counties, and Puerto Rico Commonwealth and Municipios: April 1, 2010 to July 1, 2012. Washington, DC: US Census Bureau; 2012.
34. Centers for Medicare and Medicaid Services. Medicare Geographic Variation. Baltimore, MD: Centers for Medicare and Medicaid Services; 2011.
35. Barry P. What does Medicare cost? AARP Bulletin. 2014. http://www.aarp.org/health/medicare-insurance/info-04-2011/medicare-cost.html. Accessed August 29, 2014.
36. US Government Accountability Office. Ambulance providers: costs and Medicare margins varied widely; transports of beneficiaries have increased. Report to Congressional Committees. Vol 13. Washington, DC: US Government Accountability Office; 2012.
37. Young K, Garfield R, Musumeci M, Clemans-Cope L, Lawton E. Medicaid's Role for Dual Eligible Beneficiaries. Menlo Park, CA: Kaiser Family Foundation; 2013. http://kaiserfamilyfoundation.files.wordpress.com/2013/08/7846-04-medicaids-role-for-dual-eligible-beneficiaries.pdf. Accessed August 20, 2014.
38. Medicare Payment Advisory Commission. Part D spending and utilization per enrollee, 2010 [chart 10-16]. Data Book: Health Care Spending and the Medicare Program. Washington, DC: Medicare Payment Advisory Commission; 2012.
39. New York Academy of Medicine. Independence at Home Act: A Chronic Care Coordination Program for Medicare That Has Proven Effective in Reducing Costs and Improving Quality for Highest Cost Patients. Washington, DC: New York Academy of Medicine; 2009.
40. Brown RS, Peikes D, Peterson G, Schore J, Razafindrakoto CM. Six features of Medicare coordinated care demonstration programs that cut hospital admissions of high-risk patients. Health Aff (Millwood). 2012;31(6):1156-1166.
41. Jayadevappa R, Chhatre S, Weiner M, Raziano DB. Health resource utilization and medical care cost of acute care elderly unit patients. Value Health. 2006;9(3):186-192.
42. Ouslander JG, Lamb G, Tappen R, et al. Interventions to reduce hospitalizations from nursing homes: evaluation of the INTERACT II collaborative quality improvement project. J Am Geriatr Soc. 2011;59(4):745-753.
43. Voss R, Gardner R, Baier R, Butterfield K, Lehrman S, Gravenstein S. The Care Transitions Intervention: translating from efficacy to effectiveness. Arch Intern Med. 2011;171(14):1232-1237.
44. Watkins L, Hall C, Kring D. Hospital to home: a transition program for frail older adults. Prof Case Manag. 2012;17(3):117-123.
45. Leff B, Burton L, Mader SL, et al. Hospital at home: feasibility and outcomes of a program to provide hospital-level care at home for acutely ill older patients. Ann Intern Med. 2005;143(11):798-808.
46. Dobson A, DaVanzo J, El-Gamil AM, et al. Clinically Appropriate and Cost-effective Placement: Improving Health Care Quality and Efficiency. Arlington, VA: Alliance for Home Health Quality and Innovation; 2012.
47. Bischoff KE, Sudore R, Miao Y, Boscardin WJ, Smith AK. Advance care planning and the quality of end-of-life care in older adults. J Am Geriatr Soc. 2013;61(2):209-214.
48. State of Florida Department of Elder Affairs. 2011-2012 Legislative Report: Long-term Care Community Diversion Project. Tallahassee, FL: State of Florida Department of Elder Affairs; 2012.
49. Mittelman MS, Haley WE, Clay OJ, Roth DL. Improving caregiver well-being delays nursing home placement of patients with Alzheimer disease. Neurology. 2006;67(9):1592-1599.
50. Kautter J, Pope GC. CMS frailty adjustment model. Health Care Financ Rev. 2005;26(2):1-19.
51. Crawford M, Church J, eds. CPI Detailed Report: Data for March 2014. Washington, DC: Bureau of Labor Statistics; 2014.
52. Centers for Medicare and Medicaid Services. Quarterly Index Levels in the CMS Prospective Payment System Skilled Nursing Facility Input Price Index [using IHS Global Insight Inc. (IGI) Forecast Assumptions by Expense Category: 1996-2021]. Baltimore, MD: Centers for Medicare and Medicaid Services; 2014.
53. Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, Pinder EL. The implications of regional variations in Medicare spending. Part 2: health outcomes and satisfaction with care. Ann Intern Med. 2003;138(4):288-298.
54. Scully T. Innovations in managing post-acute care. Paper presented at: Health Industry Forum; March 18, 2014; Waltham, MA: Brandeis University. http://healthforum.brandeis.edu/meetings/materials/2014-18-march/naviHealth.Scully.pdf. Accessed December 27, 2015.