Professional agency vs consumer directed care workers: Outcomes in managed care
| Autor: | Mary E. Winger, Suzanne M. Kinsky, Clark A. Veet |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Sociology and Political Science Total cost Medicare Logistic regression Race and health Article Health care medicine Humans Aged Retrospective Studies Medicaid business.industry Health Policy Managed Care Programs Public Health Environmental and Occupational Health Home Care Services Long-Term Care United States Long-term care Family medicine Managed care Female business Delivery of Health Care Social Sciences (miscellaneous) Cohort study |
| Zdroj: | Health Soc Care Community |
| ISSN: | 1365-2524 0966-0410 |
| DOI: | 10.1111/hsc.13488 |
| Popis: | Direct care workers are a major part of the long-term services and supports (LTSS) needed to address the health of individuals and accounted for $112 billion in United States spending in 2015. Direct care workers are hired within professional agency models (PAMs) or consumer-directed models (CDMs) where workers (including family) are contracted by the individual to obtain services. We sought to identify differences in cost and utilisation outcomes between PAM and CDM participants. Data were obtained from the University of Pittsburgh Medical Center (UPMC) Insurance Services Division from the participants enrolled in UPMC Community HealthChoices in Pennsylvania during 2018. A retrospective, observational cohort study design was performed using claims data. Utilisation outcomes were assessed using multivariate logistic regression and cost outcomes by linear regression. The 3,232 participants met the inclusion criteria. Of these, 69% (N = 2,217) were in a PAM, 23% (N = 752) were in a CDM, and 8% (N = 263) used a combination of services. PAM groups were older (mean 62.4 years vs 54.1 years), more likely to be women (69.0% vs 62.8%), and had more healthcare needs. Hospital utilisation was the same among groups. However, total cost was lower in CDM groups due to differences in LTSS costs between CDM and PAM services. Among dually eligible Medicare and Medicaid beneficiaries receiving LTSS, there are significant differences in age, gender, race and health needs. While hospital utilisation was not different between groups, CDM groups had lower total costs of care compared to PAM. These findings have implications for families, policymakers and insurers in helping to govern community LTSS while supporting member autonomy. |
| Databáze: | OpenAIRE |
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