Younger Individuals Increase Their Use of Nursing Homes Following ACA Medicaid Expansion
This study examines the effect of Medicaid eligibility expansion under the Affordable Care Act (ACA) on the utilization of nursing home services by younger individuals and those covered by Medicaid.
Ritter A, Freed S, Coe NB: Younger Individuals Increase Their Use of Nursing Homes Following ACA Medicaid Expansion. Journal of the American Medical Directors Association 23(5): 852-857, May 2022.
Out-of-pocket costs attributable to dementia: A longitudinal analysis
Alzheimer's disease and related dementias (ADRD) affect 5.7 million Americans, and are expensive despite the lack of a cure or even treatments effective in managing the disease. The literature thus far has tended to focus on the costs to Medicare, even though one of the main characteristics of ADRD (the loss of independence and ability to care for oneself) incurs costs not covered by Medicare. In this paper, we use survey data for 2002-2016 from the Health and Retirement Study to estimate the out-of-pocket costs of ADRD for the patient and their family through the first 8 years after the onset of symptoms, as defined by a standardized 27-point scale of cognitive ability. A two-part model developed by Basu and Manning (2010) allows us to separate the costs attributable to ADRD into two components, one driven by differences in longevity and one driven by differences in utilization.
Oney M, White L, Coe NB: Out-of-pocket costs attributable to dementia: A longitudinal analysis. Journal of the American Geriatrics Society (JAGS) 70(5): 1538-1545, May 2022.
Insurance coverage and health care spending by state-level Medigap regulations
Medigap protects traditional Medicare (TM) beneficiaries against catastrophic expenses. Federal regulations around Medigap enrollment and pricing are limited to the first 6 months after turning 65 years old. Eight states institute regulations that apply to later enrollment; half use community rating (charging everyone the same premium) and half use both community rating and guaranteed issue (requiring insurers to accept any beneficiary irrespective of health conditions). We examined the impact of state-level Medigap regulations on insurance coverage and health care spending for Medicare beneficiaries.
Park S, Coe NB: Insurance Coverage and Health Care spending by State-level Medigap Regulations. American Journal of Managed Care 28(4), Apr 2022.
Racial and ethnic disparities in access to and enrollment in high-quality Medicare Advantage plans
Racial and ethnic minority enrollees in Medicare Advantage (MA) plans tend to be in lower-quality plans, measured by a 5-star quality rating system. We examine whether differential access to high-rated plans was associated with this differential enrollment in high-rated plans by race and ethnicity among MA enrollees.
Park S, Werner RM, Coe NB: Racial and ethnic disparities in access to and enrollment in high-quality Medicare Advantage plans. Health Services Research Mar 2022 Notes: Online ahead of print.
Public spending on acute and long-term care for Alzheimer's disease and related dementias
We estimate the spending attributable to Alzheimer's disease and related dementias (ADRD) to the United States government for the first 5 years post-diagnosis.
Coe NB, White L, Oney M, Basu A, Larson EB: Public spending on acute and long-term care for Alzheimer's disease and related dementias. Alzheimer's & Dementia: the journal of the Alzheimer's Association Mar 2022 Notes: Online ahead of print.
Effects of Medicare advantage on patterns of end-of-life care among Medicare decedents
To examine the effects of Medicare Advantage (MA) enrollment on patterns of end-of-life care.
Park S, Teno JM, White L, Coe NB: Effects of Medicare advantage on patterns of end-of-life care among Medicare decedents. Health Services Research 57(4): 863-871, Feb 2022.
Evaluation and disposition of older adults presenting to the emergency department with abdominal pain
Abdominal pain is the most common chief complaint in US emergency departments (EDs) among patients over 65, who are at high risk of mortality or incident disability after the ED encounter. We sought to characterize the evaluation, management, and disposition of older adults who present to the ED with abdominal pain. We performed a survey-weighted analysis of the National Hospital Ambulatory Medical Care Survey (NHAMCS), comparing older adults with a chief complaint of abdominal pain to those without. Visits from 2013 to 2017 to nationally representative EDs were included. We analyzed 81,509 visits to 1211 US EDs, which projects to 531,780,629 ED visits after survey weighting. We report the diagnostic testing, evaluation, management, additional reasons for visit, and disposition of ED visits.
Friedman AB, Chen A, Wu RR, Coe NB, Halpern SD, Hwang U, Kelz RR, Cappola AR: Evaluation and Disposition of Older Adults Presenting to the Emergency Department with Abdominal Pain Journal of the American Geriatrics Society (JAGS) 70(2): 501-511, Feb 2022.
Informal Caregivers Provide Considerable Front-Line Support In Residential Care Facilities And Nursing Homes
Informal care, or care provided by family and friends, is the most common form of care received by community-dwelling older adults with functional limitations. However, less is known about informal care provision within residential care settings including residential care facilities (for example, assisted living) and nursing homes. Using data from the Health and Retirement Study (2016) and the National Health and Aging Trends Study (2015), we found that informal care was common among older adults with functional limitations, whether they lived in the community, a residential care facility, or a nursing home. The hours of informal care provided were also nontrivial across all settings. This evidence suggests that informal caregiving and some of the associated burdens do not end when a person transitions from the community to residential care or a nursing home setting. It also points to the large role that families play in the care and well-being of these residents, which is especially important considering the recent visitor bans during the COVID-19 epidemic. Family members are an invisible workforce in nursing homes and residential care facilities, providing considerable front-line work for their loved ones. Providers and policy makers could improve the lives of both the residents and their caregivers by acknowledging, incorporating, and supporting this workforce.
Coe NB, Werner RM: Informal Caregivers Provide Considerable Front-Line Support in Residential Care Facilities and Nursing Homes. Health Affairs 41(1): 105-111, Jan 2022.
Association of Medicare Advantage Penetration With Per Capita Spending, Emergency Department Visits, and Readmission Rates Among Fee-for-Service Medicare Beneficiaries With High Comorbidity Burden
Rapid growth of Medicare Advantage (MA) plans has the potential to change clinical practice for both MA and fee-for-service (FFS) beneficiaries, particularly for high-need, high-cost beneficiaries with multiple chronic conditions or a costly single condition. The authors assessed whether MA growth from 2010 to 2017 spilled over to county-level per capita spending, emergency department visits, and readmission rates among FFS beneficiaries, and how much this varied by the comorbidity burden of the beneficiary. The authors also examined whether the association between MA growth and per capita spending in FFS varied in beneficiaries with specific chronic conditions. MA growth was associated with decreased FFS spending and emergency department visits only among beneficiaries with six or more chronic conditions. MA growth was associated with decreased FFS spending among beneficiaries with 11 of the 20 chronic conditions. This suggests that MA growth may drive improvements in efficiency of health care delivery for high-need, high-cost beneficiaries.
Park S, Langellier BA, Burke RE, Figueroa JF, Coe NB: Association of Medicare Advantage Penetration With Per Capita Spending, Emergency Department Visits, and Readmission Rates Among Fee-for-Service Medicare Beneficiaries with High Comorbidity Burden. Medical Care Research and Review (MCRR) 78(6): 703-712, Dec 2021.
Statewide Evaluation of Washington's State Innovation Model Initiative: A Mixed-Methods Approach
The Washington State Innovation Model (SIM) $65 million Test Award from the Center for Medicare and Medicaid Innovation is a statewide intervention expected to improve population health, quality of care, and cost growth through 4 initiatives in 2016-2018: (1) regional accountable communities of health linking health and social services to address local needs; (2) a practice transformation support hub; (3) four value-based payment reform pilot projects mainly in state employee and Medicaid populations; and (4) data and analytic infrastructure development to support system transformation with common measures. A mixed-methods study design and data from the 2013-2018 Behavioral Risk Factor Surveillance System Surveys are used to estimate whether SIM resulted in changes in access to care, health behaviors, and health status in Washington's adult population. Semi-structured qualitative interviews also were conducted to assess stakeholder perceptions of SIM performance. SIM may have reduced binge drinking, but no effects were detected for heavy drinking, physical activity, smoking, having a regular doctor checkup, unmet health care needs, and fair or poor health status. Complex interventions, such as SIM, may have unintended consequences. SIM was associated unexpectedly with increased unhealthy days, but whether the association was related to the Initiative or other factors is unclear. Over 3 years, stakeholders generally agreed that SIM was implemented successfully and increased Washington's readiness for system transformation but had not yet produced expected outcomes, partly because SIM had not spread statewide. Stakeholders perceived that scaling up SIM statewide takes time to achieve and remains challenging.
Grembowski D, Ingraham B, Wood S, Coe NB, Fishman P, Conrad DA.: Statewide Evaluation of Washington's State Innovation Model Initiative: A Mixed-Methods Approach. Population Health Management 24(6): 727-737, Dec 2021.