The Effects of Home Care Provider Mix on the Care Recipient: An International, Systematic Review of Articles from 2000 to 2020
In this systematic review, we examine the literature from 2000 to 2020 to ascertain whether we can make strong conclusions about the relative benefit of adding informal care or formal care providers to the care mix among individuals receiving care in the home, specifically focusing on care recipient outcomes. We evaluate how informal care and formal care affect (or are associated with) health care use of care recipients, health care costs of care recipients, and health outcomes of care recipients. The literature to date suggests that informal care, either alone or in concert with formal care, delivers improvements in the health and well-being of older adults receiving care. The conclusions one can draw about the effects of formal care are less clear.
Coe NB, Konetzka RT, Berkowitz Melissa, Blecker Emily, Van Houtven CH: The Effects of Home Care Provider Mix on the Care Recipient: An International, Systematic Review of Articles from 2000 to 2020, Annual Review of Public Health, 42(1), Jan 2021.
In this study, the authors estimated the direct health care costs attributable to ADRD among older adults within a large MA plan. A retrospective cohort design was used to estimate direct total, outpatient, inpatient, ambulatory pharmacy, and nursing home costs for 3 years before and after an incident ADRD diagnosis for 927 individuals diagnosed with ADRD relative to a sex-matched and birth year-matched set of 2945 controls. The authors found that greater total health care costs among individuals with ADRD are primarily driven by nursing home costs.
Fishman P; White L; Ingraham B; Larson EB; Crane PK; Coe NB: Health Care Costs of Alzheimer’s and Related Dementias within a Medicare Managed Care Provider. Medical Care. Sep 2020. 58(9) 833-841
Differences in Health Care Utilization, Process of Diabetes Care, Care Satisfaction and Health Status in Patients with Diabetes in Medicare Advantage vs Traditional Medicare. Medical Care
The objective of this study was to determine differences in health care utilization, process of diabetes care, care satisfaction, and health status for Medicare Advantage (MA) and traditional Medicare (TM) beneficiaries with and without diabetes. Using the 2010–2016 Medicare Current Beneficiary Survey, the authors identified MA and TM beneficiaries with and without diabetes. To address the endogenous plan choice between MA and TM, the authors used an instrumental variable approach. Using marginal effects, the authors estimated differences in the outcomes between MA and TM beneficiaries with and without diabetes. MA enrollment was associated with lower health care utilization without compromising care satisfaction and health status, particularly for beneficiaries with diabetes. MA may have a more efficient care delivery system for beneficiaries with diabetes.
Park S, Larson EB, Fishman P, White L, Coe NB: Differences in Health Care Utilization, Process of Diabetes Care, Care Satisfaction, and Health Status in Patients With Diabetes in Medicare Advantage Versus Traditional Medicare, Medical Care: September 10, 2020 - Volume Publish Ahead of Print
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). 2020 Aug 26: Epub ahead of print.
Sociodemographic trends in the United States may influence future dementia-associated mortality, yet there is little evidence about their potential impact. The study objective was to estimate the effect of dementia on survival in adults stratified by sex, education, and marital status. Methods: Using survey data from the Health and Retirement Study (HRS) linked to Medicare claims from 1991 to 2012, the authors identified a retrospective cohort of adults with at least one International Classification of Diseases—ninth revision—Clinical Modification (ICD-9-CM) dementia diagnosis code (n = 3,714). For each case, the authors randomly selected up to five comparators, matching on sex, birth year, education, and HRS entry year (n = 9,531), and assigned comparators the diagnosis date of their matched case. The authors estimated a survival function for the entire study population and then within successive strata defined by sex, education, and marital status. Both sex and level of education moderate the relationship between dementia diagnosis and length of survival.
White L, Fishman P, Basu A, Crane PK, Larson EB, Coe NB. Dementia Is Associated With Earlier Mortality for Men and Women in the United States. Gerontology and Geriatric Medicine, 2020 Aug.
Rates of informal home care use among older adults with disabilities increased from 2004 to 2016, such that in 2016 almost three-quarters of these adults received informal home care. Informal care remains the most common source of home care, even though formal home care use grew at almost twice the rate, with a 6-percentage-point increase to 36.9 percent in 2016.
Van Houtven CH, Taggert E, Konetzka RT, Coe NB: Informal and Formal Home Care Both Increased Between 2004 and 2016, Potentially Reducing Unmet Needs of Older Adults (Data Watch). Health Affairs. August 2020.
A perspective piece discussing how COVID19 has further destabilized nursing homes and offering suggestions for how to improve long term care post-pandemic.
Werner R, Hoffman A, Coe NB: Long-Term Care Policy after Covid-19 - Solving the Nursing Home Crisis. (Perspective) The New England Journal of Medicine 382(22), May 2020.
Achieving effective, high-quality primary care for Medicare beneficiaries is a national priority as it encourages health promotion and maintenance, potentially reducing intensity of acute care services. Currently, there is ample data documenting intensity of primary care services, including rates of utilization and expenditures, for beneficiaries in fee-for-service Traditional Medicare (TM). However, less is known about the beneficiaries enrolled in Medicare Advantage (MA) plans, which now include 33% of the Medicare population. As managed care’s goal is to control costs while maintaining a high quality, MA plans may encourage greater primary care than is the case in TM. We examined whether this is the case by assessing primary care utilization and expenditures among beneficiaries in MA and TM.
Park S, Figueroa JF, Fishman P, Coe NB: Primary Care Utilization and Expenditures in Traditional Medicare and Medicare Advantage, 2007-2016. Journal of General Internal Medicine,35(8):2480-2481 May 2020.
Descriptive article covering the risk of COVID transmission in assisted living, independent living, and continuing care retirement communities.
Coe NB, Van Houtven CH. “Living Arrangements of Older Adults and COVID Risk: It is Not Just Nursing Homes.” Journal of the American Geriatrics Society. 2020. May. PMID: 32359073
Essential Long-Term Care Workers Commonly Hold Second Jobs and Double- or Triple-Duty Caregiving Roles
Long-term care (LTC) facilities are particularly dangerous places for the spread of COVID-19 given that they house vulnerable high-risk populations. Transmission-based precautions to protect residents, employees, and families alike must account for potential risks posed by LTC workers’ second jobs and unpaid care work. This observational study describes the prevalence of their (1) second jobs, and (2) unpaid care work for dependent children and/or adult relatives (double- and triple-duty caregiving) overall and by occupational group (registered nurses [RNs], licensed practical nurses [LPNs], or certified nursing assistants [CNAs]). The data used was a descriptive secondary analysis of data collected as part of the final wave of the Work, Family, and Health Study. Findings show that LTC workers commonly hold second jobs along with double- and triple-duty caregiving roles. To slow the spread of COVID-19, both the paid and unpaid activities of these employees warrant consideration in the identification of appropriate clinical, policy, and informal supports.
Van Houtven CH, DePasquale N, Coe NB: Essential Long-Term Care Workers Commonly Hold Second Jobs and Double- or Triple-Duty Caregiving Roles. Journal of the American Geriatrics Society Apr 2020.