An Aging in Place model in the innovation pipeline: testing an - - PowerPoint PPT Presentation

An Aging in Place model in the innovation pipeline: testing an evidence-based program in an Accountable Care Organization

Sarah L. Szanton, PhD ANP FAAN Health Equity and Social Justice Professor Johns Hopkins School of Nursing Director, Center for Innovative Care in Aging sarah.szanton@jhu.edu

Acknowledgements:

• Co- Authors: Judith Kell, Tonia Bourdon, James Purvis, Xuan

Zhang, Laura Gitlin.

• Funding: Trinity Health Innovations

CAPABLE IMPROVES HEALTH OUTCOMES AND LOWERS COSTS MORE THAN 6X RETURN ON INVESTMENT Roughly $3,000 in program costs yielded more than $30,000 in savings in medical costs driven by reductions in both inpatient and outpatient expenditures. HALVED DIFFICULTIES IN FUNCTION Participants had difficulty with an average of 3.9 out of 8.0 Activities of Daily Living (ADLs) at baseline, compared to 2.0 after five months. REDUCED SYMPTOMS OF DEPRESSION Symptoms of depression, as well as the ability to grocery shop and manage medications also improved. IMPROVED MOTIVATION The change in physical environment further motivates the participant. Addressing both the people and the environment in which they live allows the person to thrive.

CAPABLE Research Evidence Base-

CAPABLE Team - At a Glance

Person/Participant

Self-assessment Readiness to change Goal setting – participant driven & priorities set by participant Brainstorming options/solutions; team in consultative role Work/actions to progress between each visit – Action Plan Exercises, education, practice Absorb tips for safe independent living

OT

Functional/Mobility assessment Home risk; modifications & equipment needs Fall prevention

Handyman

Receives work order; confers with participant Obtains equipment, installs instruction/guidance for participant

RN

Person

Medical history, current healthcare

providers

Key health issues/risks Pain, depression, medication review

Active

listening, Interdisciplinary communication

Program Components Occupational Therapy – 6 visits; Nurse – 4 visits; Handyman – usually 2 visits

CAPABLE Training, Skills Development, Forms, Action Plans, & Tools – Guide: rapport building, person-directed approach, progress tracking, fidelity to evidence-base, and evaluation

27 Implementation Sites

Early Adopter Experience

• Variety of types of organizations involved as lead or in partnership:

– Healthcare delivery system/ACO – Housing organizations – Meal/nutritional home delivery organization – Home health care agency – Other community-based social service agency

• Able to secure start-up funding through grants, partnership, or self-funded
• Successful pilot/initial experience – scaling up underway
• Additional agencies and organizations interested/exploring ways to support CAPABLE

implementation: – State Medicaid agencies – Medicare program

Study Design:

• Prospective trial: CAPABLE (N= 100) with comparison to (N= 873) ACO

patients with similar demographic indices

• Site: Mercy Muskegon, MI site of Trinity Health.
• Main outcomes: care utilization of CAPABLE participants the year before

and the year after the program and in relation to those in ACO not served by CAPABLE.

Study Design:

• Prospective trial: CAPABLE (N= 100) with comparison to (N= 873) ACO

patients with similar demographic indices

• Site: Mercy Muskegon, MI site of Trinity Health.
• Main outcomes: care utilization of CAPABLE participants the year before

and the year after the program and in relation to those in ACO not served by CAPABLE.

Population studied:

• CAPABLE and ACO comparators were dually eligible for Medicaid and

Medicare.

• CAPABLE participants were 100 cognitively intact, community-dwelling

adults ages 65 and older reporting difficulty with daily tasks such as bathing.

• Mean (SD) age: 76.0 (9.0)
• Average number of chronic conditions was 4.0 for both groups.

CAPABLE participants: fewer ED, hospital stays and 90 day readmissions post treatment.

• Inpatient rates reduced from 23.0% in the year prior to receiving CAPABLE to

9.0% in the year after.

• The participants who were readmitted prior to 90 days cost $6,920 less on

average than they did prior to CAPABLE.

• The comparison group of ACO patients did not change their rates of admission
• r cost.
• The average CAPABLE participant reported a reduction in difficulty in seven

daily activities assessed such as bathing, and dressing. Ninety percent of CAPABLE participants said they felt safer and more independent in their homes.

When used by CAPABLE participants, costs for these services were lower.

• Inpatient rates reduced from 23.0% year prior to 9.0% year after.
• Participants who were readmitted prior to 90 days cost $6,920 less on average

than they did prior to CAPABLE.

• Comparison group of ACO patients did not change their rates of admission or

cost.

• Average CAPABLE participant reported reduction in difficulty in seven daily

activities such as bathing, and dressing.

• 90% of CAPABLE participants felt safer and more independent in their homes.

Implications :

• CAPABLE is being implemented in 27 places in 14 States but this is the

first replication site to report cost results.

• The reductions were lower than in initial CAPABLE program (of $30,000
• ver 2 years) but still saved more money than implementation cost.
• This implementation of CAPABLE used fewer RN and OT visits and less

handyman repair.

• New adopters may calibrate their cost savings by the intensity of the

intervention.

Policy Implications :

• Medicaid waiver for older adults,
• hospital admission reduction programs,
• Medicare Advantage
• ACOs
• PTAC for Traditional Medicare

Conclusions:

• Translating an evidence-based aging in place program was associated

with reduced costs and disability among dually eligible older adults.

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