|
This project used data from state home care programs to design a payment system that would adjust the level of resources that are budgeted to meet home care patients’ needs to match the value of those services for patients. Value is determined by individual patients’ risks of adverse outcomes, the value of those outcomes, and the effectiveness of home care in mitigating those risks. The study established that currently, home care programs’ expenditures on individual patients are not matched to their risk for adverse outcomes such as nursing home admission. A pilot test using the proposed risk budgeting model was conducted in Arizona.
The project was needed because home care patients' differing relative risk of adverse outcomes has not typically been taken into account when services are allocated. This has resulted in two failures in home care:
- average patient spending levels are set too high to be justified by patient benefits or savings associated with avoided consumption of other services, and;
- patients actually at high risk are not identified for specially designed efforts to avoid adverse outcomes, resulting in avoidable hospitalizations and institutionalizations.
The authors argue that targeting services according to risk category would be more cost efficient and could improve benefits and outcomes for the patient.
The study found that:
- Home care use does not relate well to risks, providing evidence that reform is needed. The project showed both waste and significant under-provision.
- Home care should be used in relation to risk, value and effectiveness.
- Factors that place patients at risk for nursing home care can be identified; risk is estimated more usefully on a monthly rather than annual basis.
- There is a lack of physician involvement in home care, but there are ways to encourage it: Maricopa County, AZ implemented a pilot program of physician consultation in care planning.
- There is a major deficit in research and conceptual work relating to the valuation of the outcomes of home care, its effectiveness, and dose-response relationships.
Publications
Chernew, M.E., Weissert, W.G., and Hirth, R.A. 2001.
“Heterogeneity of Risk in a Managed Home Health Care Population.”
Medical Care, 39(9):1-12.
Miller, E.A., and Weissert, W.G. 2001.
“Incidence of Four Adverse Outcomes in the Elderly Population: Implications for Long-Term Care Policy and Research.”
Home Health Care Services Quarterly, 20 (4):17-47.
Weissert, W.G. 2001.
Policy Brief: More for Less in Long-Term Home Care Services: Titrating Payment to Risk, Value and Effectiveness.
NY: Home Care Research Initiative, Center for Home Care Policy and Research, Visiting Nurse Service of NY.
Weissert, W.G., Chernew, M., and Diwan, S. 2001.
“Paying for Home Care Based Upon Risks of Adverse Outcomes: A Pilot Test.”
The Gerontologist, Under Review.
Weissert, W.G., Chernew, M., and Hirth, R. 2001.
“Beyond Managed Long-Term Care: Paying for Home Care Based upon Risks of Adverse Outcomes.”
Health Affairs, 20(3): 172-80.
Miller, E.A., and Weissert, W.G. 2000.
“Predicting Elderly People's Risk for Nursing Home Placement, Hospitalization, Functional Impairment, and Mortality: A Comparative Review and Analysis.”
Medical Care Research and Review, 57(3): 259-297.
Weissert, W.G., and Miller, E.A. 2000.
“Balancing Resources and Risk: Selecting Home care Clients in Florida’s CARES Program.”
Home Health Care Services Quarterly, 18( 4).
Weissert, W.G. 1999.
“Experts Answer Five Critical Questions About Integration of Care.”
Generations, 23(2): 57-74.
Miller, E.A., Weissert, W.G., and Chernew, M. 1998.
“Managed Care for Elderly People: A Compendium of Findings.”
American Journal of Medical Quality, 13(3): 127-140.
Weissert, W.G. 1998.
“Paying for Effective Home Care.”
The Keio Journal of Medicine, 47(Supplement 2): A104-A106.
| 
