Does Medicaid Pay More to a Program of All-Inclusive Care for the Elderly (PACE) Than for Fee-for-Service Long-term Care?

作者：Wieland Darryl^*; Kinosian Bruce; Stallard Eric; Boland Rebecca

来源：Journals of Gerontology Series A-Biological Sciences and Medical Sciences, 2013, 68(1): 47-55.

DOI：10.1093/gerona/gls137

• Long-term care financing
• Grade-of-membership analysis
• Medicare/Medicaid dual eligibles
• Managed long-term care
• Latent structure models

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%26apos;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. %26lt;br%26gt;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%26apos;s capitation is compared with blend-based expenditure predictions. %26lt;br%26gt;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%26apos;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%26apos;s Medicaid capitation was $27,648-28% below the lower limit of predicted fee-for-service payments. %26lt;br%26gt;Conclusions. PACE%26apos;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.

• 出版日期2013-1