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Does Medicaid pay more to a program of all-inclusive care for the elderly (PACE) than for fee-for-service long-term care?

dc.contributor.author Wieland, Darryl
dc.contributor.author Kinosian, Bruce
dc.contributor.author Stallard, Eric
dc.contributor.author Boland, Rebecca
dc.coverage.spatial United States
dc.date.accessioned 2017-06-08T18:16:51Z
dc.date.available 2017-06-08T18:16:51Z
dc.date.issued 2013-01
dc.identifier https://www.ncbi.nlm.nih.gov/pubmed/22565242
dc.identifier gls137
dc.identifier.uri https://hdl.handle.net/10161/14891
dc.description.abstract BACKGROUND: In rebalancing from nursing homes (NHs), states are increasing access of NH-certified dually eligible (Medicare/Medicaid) patients to community waiver programs and Programs of All-Inclusive Care for the Elderly (PACE). Prior evaluations suggest Medicaid's PACE capitation exceeds its spending for comparable admissions in alternative care, although the latter may be underestimated. We test whether Medicaid payments to PACE are lower than predicted fee-for-service outlays in a long-term care admission cohort. METHODS: Using grade-of-membership methods, we model health deficits for dual eligibles aged 55 or more entering waiver, PACE, and NH in South Carolina (n = 3,988). Clinical types, membership vectors, and program type prevalences are estimated. We calculate a blend, fitting PACE between fee-for-service cohorts, whose postadmission 1-year utilization was converted to attrition-adjusted outlays. PACE's capitation is compared with blend-based expenditure predictions. RESULTS: Four clinical types describe population health deficits/service needs. The waiver cohort is most represented in the least impaired type (1: 47.1%), NH entrants in the most disabled (4: 38.5%). Most prevalent in PACE was a dementia type, 3 (32.7%). PACE's blend was waiver: 0.5602 (95% CI: 0.5472, 0.5732) and NH: 0.4398 (0.4268, 0.4528). Average Medicaid attrition-adjusted 1-year payments for waiver and NH were $4,177 and $77,945. The mean predicted cost for PACE patients in alternative long-term care was $36,620 ($35,662 and $37,580). PACE's Medicaid capitation was $27,648-28% below the lower limit of predicted fee-for-service payments. CONCLUSIONS: PACE's capitation was well under outlays for equivalent patients in alternative care-a substantial savings for Medicaid. Our methods provide a rate-setting element for PACE and other managed long-term care.
dc.language eng
dc.publisher Oxford University Press (OUP)
dc.relation.ispartof J Gerontol A Biol Sci Med Sci
dc.relation.isversionof 10.1093/gerona/gls137
dc.subject Aged
dc.subject Cohort Studies
dc.subject Costs and Cost Analysis
dc.subject Fee-for-Service Plans
dc.subject Female
dc.subject Health Services for the Aged
dc.subject Humans
dc.subject Long-Term Care
dc.subject Male
dc.subject Managed Care Programs
dc.subject Medicaid
dc.subject Medicare
dc.subject Middle Aged
dc.subject Models, Economic
dc.subject Nursing Homes
dc.subject South Carolina
dc.subject United States
dc.title Does Medicaid pay more to a program of all-inclusive care for the elderly (PACE) than for fee-for-service long-term care?
dc.type Journal article
duke.contributor.id Wieland, Darryl|0656695
pubs.author-url https://www.ncbi.nlm.nih.gov/pubmed/22565242
pubs.begin-page 47
pubs.end-page 55
pubs.issue 1
pubs.organisational-group Center for Population Health & Aging
pubs.organisational-group Duke
pubs.organisational-group Duke Population Research Institute
pubs.organisational-group Institutes and Provost's Academic Units
pubs.organisational-group Sanford School of Public Policy
pubs.organisational-group Social Science Research Institute
pubs.organisational-group Staff
pubs.organisational-group University Institutes and Centers
pubs.publication-status Published
pubs.volume 68
dc.identifier.eissn 1758-535X


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