ABSTRACT
We estimated the effects of three Health Care Financing Administration (HCFA)-funded case management demonstrations for high-cost Medicare beneficiaries in the fee-for-service (FFS) sector. Participating beneficiaries were randomly assigned to receive case management plus regular Medicare benefits or regular benefits only. None of the demonstrations improved self-care or health or reduced Medicare spending. Despite the lack of effects of these interventions, case management might be cost-effective if it includes greater involvement of physicians, is more well-defined and goal-oriented, and incorporates financial incentives to generate savings in Medicare costs. Models incorporating these changes should be investigated before abandoning Medicare case management interventions.
Subject(s)
Case Management/organization & administration , Fee-for-Service Plans/economics , Medicare/organization & administration , Case Management/economics , Centers for Medicare and Medicaid Services, U.S. , Data Collection , Health Care Costs , Health Services Research , Humans , Medicare/economics , Models, Organizational , Pilot Projects , Self Care , United StatesABSTRACT
The purpose of this study was to present descriptive information on the characteristics of 2,873 Medicare home health clients, to quantify systematically their patterns of service utilization and allowed charges during a total episode of care, and to clarify the bivariate associations between client characteristics and utilization. The model client was female, 75-84 years of age, living with a spouse, and frail based on a variety of indicators. The mean total episode was approximately 23 visits, with allowed charges of $1,238 (1986 dollars). Specific subgroups of clients, defined by their morbidities and frailties, used identifiable clusters of services. Implications for case-mix models and implications for capitation payments under health care reform are discussed.
Subject(s)
Episode of Care , Home Care Services/statistics & numerical data , Medicare/statistics & numerical data , Aged , Data Collection , Demography , Diagnosis-Related Groups/statistics & numerical data , Fees and Charges/statistics & numerical data , Female , Home Care Services/economics , Humans , Multivariate Analysis , United StatesABSTRACT
Based on little prior information and a brief interview, the Medicare home health agency intake case manager must estimate the types and amounts of services a new client will require during the first 60 days of home care. We systematically examined the concordance between types and amounts of planned services with those actually approved and reimbursed during the first 60 days of care for a sample of 2,431 clients during 1986. Overall, the mean number of planned visits during the first 60 days was 24.76, and the mean number of approved visits was 15.95. Approved visits as a percent of planned visits averaged 64.4.
