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IIR 16-240 – HSR&D Study

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IIR 16-240
Does VA Home-Based Primary Care Reduce Costs Among Veterans Eligible for Independence at Home?
Ciaran S. Phibbs PhD MA BA
VA Palo Alto Health Care System, Palo Alto, CA
Palo Alto, CA
Funding Period: October 2017 - September 2020

BACKGROUND/RATIONALE:
The Medicare Independence-at-Home (IAH) demonstration which provides frail elderly patients with provider-managed integrated care and supportive services at home has shown reduced rates of hospitalizations, 30-day rehospitalizations, emergency department care, and an average $3,070 annual costs savings per patient. This study will examine if Veterans Affairs' (VA's) Home Based Primary Care (HBPC) program, the inceptor of IAH, produces similar outcomes among Veterans who meet IAH qualifying criteria (IAH-Q). High HBPC program costs have limited the availability of HBPC. The project will provide the Offices of Geriatrics and Extended Care Policy and Operations leadership with information needed to make informed decisions about effective expansion of the HBPC program, and tools to target Veterans who will benefit from it most.

OBJECTIVE(S):
The objectives are to: 1) determine if VA HBPC targeted to IAH qualifying Veterans achieves the same outcomes as Medicare IAH qualifying beneficiaries receiving Medicare HBPC; 2) use VA data unavailable to the Medicare evaluation; 3) determine effectiveness of VA HBPC in groups that do and do not meet IAH qualifying criteria; 4) develop criteria equivalent to IAH qualifying to identify Veterans for VA HBPC enrollment; and 5) determine how HBPC affects utilization and costs.


METHODS:
This project will use Medicare, Medicaid and VA data to capture all relevant utilization and diagnoses. We will identify all Veterans who were potentially eligible for HBPC in 2011. The intervention cohort will be all Veterans who received HBPC in 2012. The control group will be determined from those potentially eligible Veterans who did not use HBPC in 2012 using a direct demographic match, with a propensity score matching based on diagnoses, health services utilization, treatments and prescriptions and Centers for Medicare & Medicaid Services Minimum Data Set or Outcome and Assessment Information Set frailty assessments. We will follow both groups through 2015, comparing functional status, utilization of services, and costs.


FINDINGS/RESULTS:
None to date; the analysis plan requires a very large amount of dataset creations before the analyses can be conducted.

IMPACT:
Even though a Medicare demonstration has shown that a program like VA HBPC is an effective and cost-saving intervention, HBPC has been limited in size and currently serves a fraction of the Veterans who could benefit from this innovative program. This project will use VA and Medicare data to examine whether HBPC improves outcomes, keeps veterans out of nursing homes and reduces total VA spending on the cohort of Veterans who meet the equivalent Medicare IAH criteria for admission. Since HBPC provides care to Veterans not meeting the Medicare criteria, and since there are many variations of the program, this project will examine the effectiveness of variants of the program in other groups of Veterans. Finally, the project will develop a tool that program managers can use to identify Veterans who could benefit from HBPC to allow effective targeting of program resources.

PUBLICATIONS:
None at this time.


DRA: Aging, Older Veterans' Health and Care
DRE: TRL - Applied/Translational
Keywords: Home Care
MeSH Terms: none