Effect of PACE on Costs, Nursing Home Admissions, and Mortality: 2006-2011. REPORT FIGURES AND TABLES

03/01/2015

FIGURE 1a. Sample Selection Process for PACE Enrollees
Initial Sample from MARx Data Arrow pointing from left to right. Medicare Checks in MBSF Arrow pointing from left to right. Medicaid Checks in MAX Arrow pointing from left to right. Final PACE Sample
Identify beneficiaries entering PACE between July 2006 & December 2008 in any of the 8 study states. Keep in sample if:
  • Age > 66 at PACE entry.
  • FFS Medicare in prior calendar year.
  • Nonmissing Medicare expenditures & utilization in prior.
Keep in sample if:
  • MAX state matches PACE state.
  • Medicaid eligible before or within 1 month of entering PACE.
Keep in sample if:
  • Alive & enrolled in PACE (nonmissing Medicare & Medicaid capitation payments) for at least 1 month after sample entry.

 

FIGURE 1b. Sample Selection Process for HCBS Waiver Enrollees
Initial Sample from MARx Data Arrow pointing from left to right. Medicare Checks in MBSF Arrow pointing from left to right. ZIP Code Checks in MAX Arrow pointing from left to right. Final HCBS Waiver Sample
Identify beneficiaries entering type G or type H waiver program between July 2006 & December 2008 in any of the 8 study states. Keep in sample if:
  • Age > 66 at PACE entry.
  • FFS Medicare in prior calendar year.
  • Nonmissing Medicare expenditures & utilization in prior.
Keep in sample if:
  • ZIP code of residence was among the ZIP codes of residence for PACE enrollees in the same state & year of sample entry.
Keep in sample if:
  • Alive & enrolled in Medicare & Medicaid FFS (not in managed care) for at least 1 month after sample entry.

 

FIGURE 1c. Sample Selection Process for Nursing Home Entrants
Initial Sample from MARx Data Arrow pointing from left to right. Medicare Checks in MBSF Arrow pointing from left to right. ZIP Code Checks in MAX Arrow pointing from left to right. Final HCBS Waiver Sample
Identify beneficiaries entering a NH between July 2006 & December 2008 in any of the 8 study states, with the duration of the first stay being at least 21 days. Keep in sample if:
  • Age > 66 at PACE entry.
  • FFS Medicare in prior calendar year.
  • Nonmissing Medicare expenditures & utilization in prior.
Keep in sample if:
  • ZIP code of residence was among the ZIP codes of residence for PACE enrollees in the same state & year of sample entry.
Keep in sample if:
  • Alive & enrolled in Medicare & Medicaid FFS (not in managed care) for at least 1 month after sample entry.

 

  FIGURE 2a. Distribution of Estimated Propensity Scores for PACE Enrollees Matched to Both Nursing Home Entrants and HCBS Waiver Enrollees, by Group  
FIGURE 2a, Bar Chart: Propensity Score 0.0-0.1--PACE (28.7), HCBS-NH (31.3); Propensity Score 0.1-0.2--PACE (48.4), HCBS-NH (48.6); Propensity Score 0.2-0.3--PACE (19.4), HCBS-NH (17.5); Propensity Score 0.3-0.4--PACE (2.8), HCBS-NH (2.2); Propensity Score 0.4-0.5--PACE (0.6), HCBS-NH (0.4); Propensity Score 0.5-0.6--PACE (0.1), HCBS-NH (0.1).

 

  FIGURE 2b. Distribution of Estimated Propensity Scores for PACE Enrollees Matched to HCBS Waiver Enrollees Only, by Group  
FIGURE 2b, Bar Chart: Propensity Score 0.0-0.1--PACE (9.7), HCBS (12.5); Propensity Score 0.1-0.2--PACE (16.6), HCBS (19.6); Propensity Score 0.2-0.3--PACE (22.0), HCBS (23.9); Propensity Score 0.3-0.4--PACE (22.0), HCBS (21.7); Propensity Score 0.4-0.5--PACE (15.7), HCBS (13.2); Propensity Score 0.5-0.6--PACE (9.1), HCBS (6.2); Propensity Score 0.6-0.7--PACE (3.7), HCBS (2.4); Propensity Score 0.7-0.8--PACE (1.1), HCBS (0.5); Propensity Score 0.8-0.9--PACE (0.1).

 

TABLE 1. Distribution of the Matched Sample across the Study States for PACE Enrollees Matched to Both NH Entrants and HCBS Waiver Enrollees or Matched to HCBS Waiver Enrollees Alone, by Group
State PACE
  Enrollees  
Matched Comparison Group A Comprised of
NH Entrants and HCBS Waiver Enrollees
  Matched Comparison Group B  
Comprised of HCBS
Waiver Enrollees Only
All   NH Entrants     HCBS Waiver Enrollees  
California 661 579 453 126 396
Colorado 405 319 145 174 278
Massachusetts   821 710 422 288 593
Michigan 164 143 108 35 106
New Mexico 118 86 42 44 75
New York 952 901 404 497 840
Oregon 155 139 46 93 123
Pennsylvania 449 387 214 173 334
Total 3,725   3,264   1,834 1,430 2,745
NOTE: The matched comparison group A consists of a total of 3,264 sample members, of whom 1,834 are NH entrants and 1,430 are HCBS waiver enrollees. Matched comparison group B consists of a total of 2,745 HCBS waiver enrollees only.

 

TABLE 2. Sample Characteristics at Program Entry for PACE Enrollees Matched to Both NH Entrants and HCBS Waiver Enrollees or Match to HCBS Waiver Enrollees Alone, by Group
(percentages, unless otherwise noted)
  PACE
Group
  Matched Comparison  
Group A
  p-value     Matched Comparison  
Group B
  p-value  
Age 79.08 79.08 0.99 79.15 0.76
Female 0.70 0.70 0.84 0.71 0.65
Race/Ethnicity
   White 0.59 0.58 0.97 0.58 0.84
   African American 0.18 0.18 0.18
   Hispanic 0.08 0.09 0.08
   Other 0.15 0.15 0.16
Chronic Conditions
   Alzheimer's disease or dementia 0.35 0.35 0.81 0.35 0.59
   CAD 0.42 0.42 0.95 0.42 0.91
   CHF 0.28 0.28 0.86 0.27 0.30
   Depression 0.22 0.22 0.83 0.21 0.32
   Diabetes 0.36 0.35 0.78 0.35 0.70
   Stroke 0.10 0.09 0.30 0.09 0.22
   Number of chronic diseases 4.80 4.75 0.49 4.73 0.29
Service Use and Costs
   Any inpatient admissions 0.32 0.33 0.68 0.32 0.91
   Any ER visits 0.45 0.44 0.87 0.43 0.19
   Any SNF stays 0.13 0.11 0.04 0.11 0.14
   Any Home Health use 0.27 0.26 0.94 0.28 0.31
   Average annualized Medicare expenditures   $14,302   $14,625 0.60 $14,211 0.89
F-Statistic for the joint equality of means on all variables used in matching (p-value)   0.64
(0.96)
0.71
(0.80)
Variables not used in matching
Enrolled in Medicaid in the 12 months prior to sample entry 0.79 0.77 0.01 0.81 0.14
Any NH stay in the 90 days prior to sample entry 0.07 0.02 <0.01 0.05 <0.01
Number of enrollees (unweighted) 3,725 3,264   2.745  
NOTE: The matched comparison group A consists of a total of 3,264 sample members, of whom 1,834 are NH entrants and 1,430 are HCBS waiver enrollees. Matched comparison group B consists of a total of 2,745 HCBS waiver enrollees only. The means for the comparison groups were calculated using propensity score matching weights that are equal to the number of the treatment group members each comparison group member was matched to. Hence, the weighted number of enrollees in the matched comparison group is equal to that in the treatment group (3,725).

 

TABLE 3. Estimated Effect of PACE on PBPM Expenditures (dollars) with Matched Comparison Group Members Comprised of Both NH Entrants and HCBS Waiver Enrollees
  Months from Entry   Number of
  PACE Enrollees  
Actual Mean
  for PACE Group  
Predicted Mean
  for PACE Group  
  Estimated  
Effect
  p-value  
Medicare Expenditures
   1 to 6 3,725 $2,040 $4,031 -$1,991 0.00
   7 to 12 3,277 $2,257 $2,393 -$136 0.17
   13 to 18 2,946 $2,326 $2,091 $234 0.02
   19 to 24 2,187 $2,348 $2,159 $190 0.13
   25 to 30 1,496 $2,330 $2,010 $320 0.05
   31 to 36 911 $2,327 $2,345 -$17 0.93
   37 to 42 441 $2,362 $2,234 $128 0.80
   43 to 48 411 $2,357 $2,452 -$94 0.77
   49 to 54 372 $2,269 $1,739 $530 0.16
   55 to 60 330 $2,110 $1,665 $445 0.05
   61 to 66 306 $2,030 $2,374 -$344 0.45
Medicaid Expenditures
   1 to 6 3,725 $3,744 $3,152 $593 0.00
   7 to 12 3,277 $3,764 $3,203 $561 0.00
   13 to 18 2,946 $3,830 $3,264 $566 0.00
   19 to 24 2,187 $3,880 $3,281 $598 0.00
   25 to 30 1,496 $3,943 $3,346 $597 0.00
   31 to 36 911 $4,012 $3,466 $546 0.00
   37 to 42 441 $4,128 $3,481 $647 0.00
Medicare and Medicaid Expenditures
   1 to 6 3,725 $5,784 $7,183 -$1,399 0.00
   7 to 12 3,277 $6,021 $5,596 $426 0.00
   13 to 18 2,946 $6,156 $5,356 $800 0.00
   19 to 24 2,187 $6,228 $5,440 $788 0.00
   25 to 30 1,496 $6,273 $5,356 $917 0.00
   31 to 36 911 $6,339 $5,811 $528 0.01
   37 to 42 441 $6,490 $5,714 $775 0.13
NOTE: The matched comparison group consists of both NH entrants and HCBS waiver enrollees. Actual means for PACE enrollees are weighted by eligibility weights, defined as the number of months a beneficiary was alive and enrolled in PACE during each 6-month interval. Predicted means for PACE enrollees were obtained by first estimating a separate linear regression for each measurement period and outcome variable on the matched comparison group that controlled for demographics, chronic conditions, pre-enrollment Medicare service utilization and costs, months between the end of the pre-enrollment period and sample entry, indicator for any NH use in the 90 days prior to sample entry, and state indicators. The regressions incorporated the final weight for matched comparison group members obtained by multiplying the eligibility weights--defined as the number of months alive and not in managed care during each 6-month interval--with the propensity score matching weights. The estimated coefficients from these regressions were then used to predict expenditures for PACE enrollees in each interval, using the mean characteristics of the PACE sample in the equation. In some cases, the estimated effect is not exactly equal to the difference in means due to rounding.

ADDITIONAL NOTE: After this report was posted, we received information from the National PACE Association noting that Medicaid amounts for PACE enrollees in California appear to be inconsistent with capitation rates for PACE plans published by the California Department of Health Care Services. We are working to resolve this issue and will amend entries in this table and associated discussion in the text if changes are required.

 

TABLE 4. Estimated Effect of PACE on PBPM Expenditures--After Excluding PACE Enrollees with Prior HCBS Enrollment or NH Use and Excluding HCBS Enrollees with Prior NH Use
(dollars)
  Months from Entry   Number of
  PACE Enrollees  
Actual Mean
  for PACE Group  
Predicted Mean
  for PACE Group  
  Estimated  
Effect
  p-value  
Medicare Expenditures
   1 to 6 3,119 $1,958 $3,909 -$1,951 0.00
   7 to 12 2,757 $2,180 $2,436 -$256 0.01
   13 to 18 2,515 $2,267 $2,233 $34 0.75
   19 to 24 1,904 $2,298 $2,124 $173 0.23
   25 to 30 1,320 $2,283 $2,080 $202 0.25
   31 to 36 814 $2,278 $1,917 $361 0.19
   37 to 42 399 $2,324 $2,519 -$195 0.56
   43 to 48 373 $2,328 $2,418 -$89 0.77
   49 to 54 337 $2,241 $1,972 $269 0.44
   55 to 60 298 $2,103 $2,234 -$131 0.70
   61 to 66 278 $2,024 $2,540 -$516 0.14
Medicaid Expenditures
   1 to 6 3,119 $3,811 $3,352 $458 0.00
   7 to 12 2,757 $3,820 $3,263 $557 0.00
   13 to 18 2,515 $3,880 $3,300 $580 0.00
   19 to 24 1,904 $3,922 $3,452 $471 0.00
   25 to 30 1,320 $3,981 $3,426 $555 0.00
   31 to 36 814 $4,047 $3,363 $684 0.00
   37 to 42 399 $4,180 $3,217 $964 0.00
Medicare and Medicaid Expenditures
   1 to 6 3,119 $5,769 $7,261 -$1,492 0.00
   7 to 12 2,757 $6,001 $5,700 $301 0.01
   13 to 18 2,515 $6,147 $5,533 $614 0.00
   19 to 24 1,904 $6,220 $5,576 $644 0.00
   25 to 30 1,320 $6,264 $5,506 $757 0.00
   31 to 36 814 $6,325 $5,280 $1,044 0.00
   37 to 42 399 $6,504 $5,736 $769 0.03
NOTE: The matched comparison group consists of both NH entrants and HCBS waiver enrollees. Actual means for PACE enrollees are weighted by eligibility weights, defined as the number of months a beneficiary was alive and enrolled in PACE during each 6-month interval. Predicted means for PACE enrollees were obtained by first estimating a separate linear regression for each measurement period and outcome variable on the matched comparison group that controlled for demographics, chronic conditions, pre-enrollment Medicare service utilization and costs, months between the end of the pre-enrollment period and sample entry, indicator for any NH use in the 90 days prior to sample entry, and state indicators. The regressions incorporated the final weight for matched comparison group members obtained by multiplying the eligibility weights--defined as the number of months alive and not in managed care during each 6-month interval--with the propensity score matching weights. The estimated coefficients from these regressions were then used to predict expenditures for PACE enrollees in each interval, using the mean characteristics of the PACE sample in the equation. In some cases, the estimated effect is not exactly equal to the difference in means due to rounding.

ADDITIONAL NOTE: After this report was posted, we received information from the National PACE Association noting that Medicaid amounts for PACE enrollees in California appear to be inconsistent with capitation rates for PACE plans published by the California Department of Health Care Services. We are working to resolve this issue and will amend entries in this table and associated discussion in the text if changes are required.

 

TABLE 5. Estimated Effect of PACE on PBPM Expenditures with Matched Comparison Group Members Comprised of Both NH Entrants and HCBS Waiver Enrollees--After Excluding New York
(dollars)
  Months from Entry   Number of
  PACE Enrollees  
Actual Mean
  for PACE Group  
Predicted Mean
  for PACE Group  
  Estimated  
Effect
  p-value  
Medicare Expenditures
   1 to 6 2,773 $2,009 $4,211 -$2,201 0.00
   7 to 12 2,450 $2,245 $2,453 -$208 0.06
   13 to 18 2,197 $2,321 $2,127 $194 0.10
   19 to 24 1,613 $2,330 $2,234 $95 0.52
   25 to 30 1,078 $2,312 $2,150 $163 0.41
   31 to 36 631 $2,315 $2,400 -$85 0.78
   37 to 42 295 $2,292 $2,323 -$31 0.98
   43 to 48 273 $2,267 $2,675 -$409 0.56
   49 to 54 251 $2,156 $1,572 $584 0.07
   55 to 60 225 $1,999 $1,474 $525 0.16
   61 to 66 205 $1,979 $2,295 -$316 0.71
Medicaid Expenditures
   1 to 6 2,773 $3,719 $2,729 $990 0.00
   7 to 12 2,450 $3,785 $2,730 $1,054 0.00
   13 to 18 2,197 $3,882 $2,812 $1,070 0.00
   19 to 24 1,613 $3,946 $2,862 $1,084 0.00
   25 to 30 1,078 $4,045 $2,908 $1,136 0.00
   31 to 36 631 $4,154 $3,094 $1,060 0.00
   37 to 42 295 $4,358 $3,035 $1,323 0.00
Medicare and Medicaid Expenditures
   1 to 6 2,773 $5,729 $6,939 -$1,211 0.00
   7 to 12 2,450 $6,029 $5,183 $846 0.00
   13 to 18 2,197 $6,204 $4,939 $1,264 0.00
   19 to 24 1,613 $6,276 $5,096 $1,179 0.00
   25 to 30 1,078 $6,357 $5,058 $1,299 0.00
   31 to 36 631 $6,469 $5,493 $975 0.00
   37 to 42 295 $6,650 $5,358 $1,292 0.23
NOTE: The matched comparison group consists of both NH entrants and HCBS waiver enrollees. Actual means for PACE enrollees are weighted by eligibility weights, defined as the number of months a beneficiary was alive and enrolled in PACE during each 6-month interval. Predicted means for PACE enrollees were obtained by first estimating a separate linear regression for each measurement period and outcome variable on the matched comparison group that controlled for demographics, chronic conditions, pre-enrollment Medicare service utilization and costs, months between the end of the pre-enrollment period and sample entry, indicator for any NH use in the 90 days prior to sample entry, and state indicators. The regressions incorporated the final weight for matched comparison group members obtained by multiplying the eligibility weights--defined as the number of months alive and not in managed care during each 6-month interval--with the propensity score matching weights. The estimated coefficients from these regressions were then used to predict expenditures for PACE enrollees in each interval, using the mean characteristics of the PACE sample in the equation. In some cases, the estimated effect is not exactly equal to the difference in means due to rounding.

ADDITIONAL NOTE: After this report was posted, we received information from the National PACE Association noting that Medicaid amounts for PACE enrollees in California appear to be inconsistent with capitation rates for PACE plans published by the California Department of Health Care Services. We are working to resolve this issue and will amend entries in this table and associated discussion in the text if changes are required.

 

TABLE 6. Estimated Effect of PACE on PBPM Expenditures in California with Matched Comparison Group Members Comprised of Both NH Entrants and HCBS Waiver Enrollees
(dollars)
  Months from Entry   Number of
  PACE Enrollees  
Actual Mean
  for PACE Group  
Predicted Mean
  for PACE Group  
  Estimated  
Effect
  p-value  
Medicare Expenditures
   1 to 6 661 $1,731 $6,116 -$4,384 0.00
   7 to 12 580 $1,958 $2,886 -$928 0.00
   13 to 18 530 $2,061 $2,649 -$588 0.04
   19 to 24 400 $2,087 $2,726 -$638 0.08
   25 to 30 300 $2,055 $2,357 -$301 0.40
   31 to 36 201 $2,032 $2,383 -$351 0.57
   37 to 42 114 $2,097 $1,827 $270 0.86
   43 to 48 109 $2,262 $3,077 -$815 0.64
   49 to 54 102 $2,140 $1,935 $205 0.81
   55 to 60 93 $1,955 $868 $1,087 0.28
   61 to 66 86 $1,905 $2,185 -$280 0.91
Medicaid Expenditures
   1 to 6 661 $5,296 $3,721 $1,574 0.00
   7 to 12 580 $5,458 $3,042 $2,416 0.00
   13 to 18 530 $5,717 $2,932 $2,786 0.00
   19 to 24 400 $5,861 $2,852 $3,009 0.00
   25 to 30 300 $5,863 $3,043 $2,820 0.00
   31 to 36 201 $5,879 $2,871 $3,009 0.00
   37 to 42 114 $5,896 $3,225 $2,672 0.00
Medicare and Medicaid Expenditures
   1 to 6 661 $7,027 $9,837 -$2,810 0.00
   7 to 12 580 $7,416 $5,927 $1,488 0.00
   13 to 18 530 $7,778 $5,580 $2,198 0.00
   19 to 24 400 $7,949 $5,578 $2,371 0.00
   25 to 30 300 $7,918 $5,400 $2,518 0.00
   31 to 36 201 $7,912 $5,253 $2,658 0.00
   37 to 42 114 $7,994 $5,052 $2,942 0.07
NOTE: The matched comparison group consists of both NH entrants and HCBS waiver enrollees. Actual means for PACE enrollees are weighted by eligibility weights, defined as the number of months a beneficiary was alive and enrolled in PACE during each 6-month interval. Predicted means for PACE enrollees were obtained by first estimating a separate linear regression for each measurement period and outcome variable on the matched comparison group that controlled for demographics, chronic conditions, pre-enrollment Medicare service utilization and costs, months between the end of the pre-enrollment period and sample entry, indicator for any NH use in the 90 days prior to sample entry, and state indicators. The regressions incorporated the final weight for matched comparison group members obtained by multiplying the eligibility weights--defined as the number of months alive and not in managed care during each 6-month interval--with the propensity score matching weights. The estimated coefficients from these regressions were then used to predict expenditures for PACE enrollees in each interval, using the mean characteristics of the PACE sample in the equation. In some cases, the estimated effect is not exactly equal to the difference in means due to rounding.

ADDITIONAL NOTE: After this report was posted, we received information from the National PACE Association noting that Medicaid amounts for PACE enrollees in California appear to be inconsistent with capitation rates for PACE plans published by the California Department of Health Care Services. We are working to resolve this issue and will amend entries in this table and associated discussion in the text if changes are required.

 

TABLE 7. Estimated Effect of PACE on PBPM Expenditures in Massachusetts with Matched Comparison Group Members Comprised of Both NH Entrants and HCBS Waiver Enrollees
(dollars)
  Months from Entry   Number of
  PACE Enrollees  
Actual Mean
  for PACE Group  
Predicted Mean
  for PACE Group  
  Estimated  
Effect
  p-value  
Medicare Expenditures
   1 to 6 821 $2,196 $4,775 -$2,579 0.00
   7 to 12 726 $2,486 $2,408 $78 0.74
   13 to 18 661 $2,526 $1,962 $564 0.02
   19 to 24 480 $2,464 $2,077 $387 0.17
   25 to 30 313 $2,450 $2,108 $341 0.19
   31 to 36 162 $2,531 $2,540 -$8 0.99
Medicaid Expenditures
   1 to 6 821 $3,210 $2,562 $648 0.00
   7 to 12 726 $3,235 $2,792 $443 0.00
   13 to 18 661 $3,237 $2,920 $317 0.01
   19 to 24 480 $3,243 $3,057 $186 0.22
   25 to 30 313 $3,244 $3,159 $85 0.60
   31 to 36 162 $3,283 $3,111 $172 0.41
Medicare and Medicaid Expenditures
   1 to 6 821 $5,406 $7,337 -$1,931 0.00
   7 to 12 726 $5,720 $5,200 $520 0.05
   13 to 18 661 $5,763 $4,881 $882 0.00
   19 to 24 480 $5,708 $5,135 $573 0.07
   25 to 30 313 $5,694 $5,267 $426 0.14
   31 to 36 162 $5,814 $5,650 $164 0.76
NOTE: The matched comparison group consists of both NH entrants and HCBS waiver enrollees. Actual means for PACE enrollees are weighted by eligibility weights, defined as the number of months a beneficiary was alive and enrolled in PACE during each 6-month interval. Predicted means for PACE enrollees were obtained by first estimating a separate linear regression for each measurement period and outcome variable on the matched comparison group that controlled for demographics, chronic conditions, pre-enrollment Medicare service utilization and costs, months between the end of the pre-enrollment period and sample entry, indicator for any NH use in the 90 days prior to sample entry, and state indicators. The regressions incorporated the final weight for matched comparison group members obtained by multiplying the eligibility weights--defined as the number of months alive and not in managed care during each 6-month interval--with the propensity score matching weights. The estimated coefficients from these regressions were then used to predict expenditures for PACE enrollees in each interval, using the mean characteristics of the PACE sample in the equation. In some cases, the estimated effect is not exactly equal to the difference in means due to rounding.

 

TABLE 8. Estimated Effect of PACE on PBPM Expenditures in New York with Matched Comparison Group Members Comprised of Both NH Entrants and HCBS Waiver Enrollees
(dollars)
  Months from Entry   Number of
  PACE Enrollees  
Actual Mean
  for PACE Group  
Predicted Mean
  for PACE Group  
  Estimated  
Effect
  p-value  
Medicare Expenditures
   1 to 6 952 $2,128 $3,669 -$1,541 0.00
   7 to 12 827 $2,296 $2,253 $43 0.86
   13 to 18 749 $2,339 $1,925 $415 0.05
   19 to 24 574 $2,400 $2,192 $208 0.42
   25 to 30 418 $2,375 $1,906 $470 0.12
   31 to 36 280 $2,356 $1,954 $402 0.20
   37 to 42 146 $2,504 $1,863 $641 0.17
   43 to 48 138 $2,540 $1,748 $792 0.01
   49 to 54 121 $2,507 $2,053 $454 0.51
   55 to 60 105 $2,343 $1,616 $727 0.05
   61 to 66 101 $2,112 $1,767 $346 0.64
Medicaid Expenditures
   1 to 6 952 $3,819 $4,493 -$674 0.00
   7 to 12 827 $3,701 $4,699 -$998 0.00
   13 to 18 749 $3,675 $4,610 -$936 0.00
   19 to 24 574 $3,692 $4,604 -$911 0.00
   25 to 30 418 $3,683 $4,729 -$1,046 0.00
   31 to 36 280 $3,689 $4,658 -$969 0.00
   37 to 42 146 $3,662 $4,489 -$827 0.00
Medicare and Medicaid Expenditures
   1 to 6 952 $5,947 $8,162 -$2,215 0.00
   7 to 12 827 $5,997 $6,952 -$955 0.00
   13 to 18 749 $6,014 $6,535 -$521 0.13
   19 to 24 574 $6,092 $6,796 -$704 0.02
   25 to 30 418 $6,059 $6,635 -$576 0.12
   31 to 36 280 $6,045 $6,612 -$566 0.10
   37 to 42 146 $6,166 $6,352 -$186 0.71
NOTE: The matched comparison group consists of both NH entrants and HCBS waiver enrollees. Actual means for PACE enrollees are weighted by eligibility weights, defined as the number of months a beneficiary was alive and enrolled in PACE during each 6-month interval. Predicted means for PACE enrollees were obtained by first estimating a separate linear regression for each measurement period and outcome variable on the matched comparison group that controlled for demographics, chronic conditions, pre-enrollment Medicare service utilization and costs, months between the end of the pre-enrollment period and sample entry, indicator for any NH use in the 90 days prior to sample entry, and state indicators. The regressions incorporated the final weight for matched comparison group members obtained by multiplying the eligibility weights--defined as the number of months alive and not in managed care during each 6-month interval--with the propensity score matching weights. The estimated coefficients from these regressions were then used to predict expenditures for PACE enrollees in each interval, using the mean characteristics of the PACE sample in the equation. In some cases, the estimated effect is not exactly equal to the difference in means due to rounding.

 

TABLE 9. Estimated Effect of PACE on PBPM Expenditures (dollars) with Matched Comparison Group Members Comprised of HCBS Waiver Enrollees Alone
  Months from Entry   Number of
  PACE Enrollees  
Actual Mean
  for PACE Group  
Predicted Mean
  for PACE Group  
  Estimated  
Effect
  p-value  
Medicare Expenditures
   1 to 6 3,725 $2,040 $2,081 -$42 0.54
   7 to 12 3,277 $2,257 $2,014 $243 0.00
   13 to 18 2,946 $2,326 $2,038 $288 0.00
   19 to 24 2,187 $2,348 $2,017 $331 0.00
   25 to 30 1,496 $2,330 $1,998 $333 0.04
   31 to 36 911 $2,327 $2,215 $112 0.67
   37 to 42 441 $2,362 $2,155 $207 0.40
   43 to 48 411 $2,357 $2,246 $112 0.68
   49 to 54 372 $2,269 $1,485 $784 0.00
   55 to 60 330 $2,110 $1,773 $337 0.22
   61 to 66 306 $2,030 $1,847 $183 0.59
Medicaid Expenditures
   1 to 6 3,725 $3,744 $1,729 $2,016 0.00
   7 to 12 3,277 $3,764 $2,122 $1,642 0.00
   13 to 18 2,946 $3,830 $2,333 $1,497 0.00
   19 to 24 2,187 $3,880 $2,465 $1,414 0.00
   25 to 30 1,496 $3,943 $2,643 $1,300 0.00
   31 to 36 911 $4,012 $2,802 $1,210 0.00
   37 to 42 441 $4,128 $2,844 $1,284 0.00
Medicare and Medicaid Expenditures
   1 to 6 3,725 $5,784 $3,810 $1,974 0.00
   7 to 12 3,277 $6,021 $4,136 $1,885 0.00
   13 to 18 2,946 $6,156 $4,370 $1,785 0.00
   19 to 24 2,187 $6,228 $4,483 $1,745 0.00
   25 to 30 1,496 $6,273 $4,640 $1,633 0.00
   31 to 36 911 $6,339 $5,016 $1,323 0.00
   37 to 42 441 $6,490 $4,999 $1,490 0.00
NOTE: The matched comparison group consists of HCBS waiver enrollees. Actual means for PACE enrollees are weighted by eligibility weights, defined as the number of months a beneficiary was alive and enrolled in PACE during each 6-month interval. Predicted means for PACE enrollees were obtained by first estimating a separate linear regression for each measurement period and outcome variable on the matched comparison group that controlled for demographics, chronic conditions, pre-enrollment Medicare service utilization and costs, months between the end of the pre-enrollment period and sample entry, indicator for any NH use in the 90 days prior to sample entry, and state indicators. The regressions incorporated the final weight for matched comparison group members obtained by multiplying the eligibility weights--defined as the number of months alive and not in managed care during each 6-month interval--with the propensity score matching weights. The estimated coefficients from these regressions were then used to predict expenditures for PACE enrollees in each interval, using the mean characteristics of the PACE sample in the equation. In some cases, the estimated effect is not exactly equal to the difference in means due to rounding.

ADDITIONAL NOTE: After this report was posted, we received information from the National PACE Association noting that Medicaid amounts for PACE enrollees in California appear to be inconsistent with capitation rates for PACE plans published by the California Department of Health Care Services. We are working to resolve this issue and will amend entries in this table and associated discussion in the text if changes are required.

 

TABLE 10. Estimated Effect of PACE on PBPM Expenditures in California (dollars) with Matched Comparison Group Members Comprised of HCBS Waiver Enrollees Alone
  Months from Entry   Number of
  PACE Enrollees  
Actual Mean
  for PACE Group  
Predicted Mean
  for PACE Group  
  Estimated  
Effect
  p-value  
Medicare Expenditures
   1 to 6 661 $1,731 $1,927 -$196 0.24
   7 to 12 580 $1,958 $1,875 $83 0.64
   13 to 18 530 $2,061 $2,119 -$58 0.85
   19 to 24 400 $2,087 $1,786 $301 0.35
   25 to 30 300 $2,055 $1,632 $424 0.15
   31 to 36 201 $2,032 $3,534 -$1,502 0.18
   37 to 42 114 $2,097 $1,412 $685 0.54
   43 to 48 109 $2,262 $1,093 $1,169 0.44
   49 to 54 102 $2,140 $1,512 $628 0.32
   55 to 60 93 $1,955 $902 $1,053 0.28
   61 to 66 86 $1,905 $770 $1,135 0.26
Medicaid Expenditures
   1 to 6 661 $5,296 $1,758 $3,538 0.00
   7 to 12 580 $5,458 $2,045 $3,413 0.00
   13 to 18 530 $5,717 $2,214 $3,503 0.00
   19 to 24 400 $5,861 $2,219 $3,643 0.00
   25 to 30 300 $5,863 $2,486 $3,377 0.00
   31 to 36 201 $5,879 $2,491 $3,388 0.00
   37 to 42 114 $5,896 $2,626 $3,270 0.00
Medicare and Medicaid Expenditures
   1 to 6 661 $7,027 $3,685 $3,342 0.00
   7 to 12 580 $7,416 $3,920 $3,496 0.00
   13 to 18 530 $7,778 $4,333 $3,445 0.00
   19 to 24 400 $7,949 $4,005 $3,944 0.00
   25 to 30 300 $7,918 $4,117 $3,801 0.00
   31 to 36 201 $7,912 $6,025 $1,887 0.10
   37 to 42 114 $7,994 $4,039 $3,955 0.01
NOTE: The matched comparison group consists of HCBS waiver enrollees. Actual means for PACE enrollees are weighted by eligibility weights, defined as the number of months a beneficiary was alive and enrolled in PACE during each 6-month interval. Predicted means for PACE enrollees were obtained by first estimating a separate linear regression for each measurement period and outcome variable on the matched comparison group that controlled for demographics, chronic conditions, pre-enrollment Medicare service utilization and costs, months between the end of the pre-enrollment period and sample entry, indicator for any NH use in the 90 days prior to sample entry, and state indicators. The regressions incorporated the final weight for matched comparison group members obtained by multiplying the eligibility weights--defined as the number of months alive and not in managed care during each 6-month interval--with the propensity score matching weights. The estimated coefficients from these regressions were then used to predict expenditures for PACE enrollees in each interval, using the mean characteristics of the PACE sample in the equation. In some cases, the estimated effect is not exactly equal to the difference in means due to rounding.

ADDITIONAL NOTE: After this report was posted, we received information from the National PACE Association noting that Medicaid amounts for PACE enrollees in California appear to be inconsistent with capitation rates for PACE plans published by the California Department of Health Care Services. We are working to resolve this issue and will amend entries in this table and associated discussion in the text if changes are required.

 

TABLE 11. Estimated Effect of PACE on PBPM Expenditures in Massachusetts (dollars) with Matched Comparison Group Members Comprised of HCBS Waiver Enrollees Alone
  Months from Entry   Number of
  PACE Enrollees  
Actual Mean
  for PACE Group  
Predicted Mean
  for PACE Group  
  Estimated  
Effect
  p-value  
Medicare Expenditures
   1 to 6 821 $2,196 $2,644 -$448 0.02
   7 to 12 726 $2,486 $2,536 -$50 0.80
   13 to 18 661 $2,526 $2,469 $57 0.75
   19 to 24 480 $2,464 $2,057 $407 0.09
   25 to 30 313 $2,450 $2,221 $229 0.48
   31 to 36 162 $2,531 $1,858 $673 0.07
Medicaid Expenditures
   1 to 6 821 $3,210 $1,279 $1,931 0.00
   7 to 12 726 $3,235 $1,817 $1,418 0.00
   13 to 18 661 $3,237 $2,160 $1,077 0.00
   19 to 24 480 $3,243 $2,198 $1,045 0.00
   25 to 30 313 $3,244 $2,180 $1,064 0.00
   31 to 36 162 $3,283 $2,438 $844 0.00
Medicare and Medicaid Expenditures
   1 to 6 821 $5,406 $3,923 $1,483 0.00
   7 to 12 726 $5,720 $4,353 $1,368 0.00
   13 to 18 661 $5,763 $4,629 $1,134 0.00
   19 to 24 480 $5,708 $4,255 $1,453 0.00
   25 to 30 313 $5,694 $4,401 $1,293 0.00
   31 to 36 162 $5,814 $4,297 $1,518 0.00
NOTE: For Massachusetts, we only report results through month 36 after sample entry, due to very small sample sizes (fewer than 70 PACE enrollees) in later intervals. The matched comparison group consists of HCBS waiver enrollees. Actual means for PACE enrollees are weighted by eligibility weights, defined as the number of months a beneficiary was alive and enrolled in PACE during each 6-month interval. Predicted means for PACE enrollees were obtained by first estimating a separate linear regression for each measurement period and outcome variable on the matched comparison group that controlled for demographics, chronic conditions, pre-enrollment Medicare service utilization and costs, months between the end of the pre-enrollment period and sample entry, indicator for any NH use in the 90 days prior to sample entry, and state indicators. The regressions incorporated the final weight for matched comparison group members obtained by multiplying the eligibility weights--defined as the number of months alive and not in managed care during each 6-month interval--with the propensity score matching weights. The estimated coefficients from these regressions were then used to predict expenditures for PACE enrollees in each interval, using the mean characteristics of the PACE sample in the equation. In some cases, the estimated effect is not exactly equal to the difference in means due to rounding.

 

TABLE 12. Estimated Effect of PACE on PBPM Expenditures in New York (dollars) with Matched Comparison Group Members Comprised of HCBS Waiver Enrollees Alone
  Months from Entry   Number of
  PACE Enrollees  
Actual Mean
  for PACE Group  
Predicted Mean
  for PACE Group  
  Estimated  
Effect
  p-value  
Medicare Expenditures
   1 to 6 952 $2,128 $1,360 $768 0.00
   7 to 12 827 $2,296 $1,330 $966 0.00
   13 to 18 749 $2,339 $1,591 $748 0.00
   19 to 24 574 $2,400 $1,650 $750 0.00
   25 to 30 418 $2,375 $1,537 $838 0.01
   31 to 36 280 $2,356 $1,404 $952 0.01
   37 to 42 146 $2,504 $1,868 $636 0.22
   43 to 48 138 $2,540 $1,754 $786 0.10
   49 to 54 121 $2,507 $1,243 $1,264 0.00
   55 to 60 105 $2,343 $1,639 $704 0.27
   61 to 66 101 $2,112 $2,387 -$275 0.62
Medicaid Expenditures
   1 to 6 952 $3,819 $3,175 $644 0.00
   7 to 12 827 $3,701 $3,428 $273 0.00
   13 to 18 749 $3,675 $3,568 $107 0.21
   19 to 24 574 $3,692 $3,579 $113 0.27
   25 to 30 418 $3,683 $3,897 -$214 0.09
   31 to 36 280 $3,689 $3,867 -$177 0.31
   37 to 42 146 $3,662 $4,040 -$377 0.16
Medicare and Medicaid Expenditures
   1 to 6 952 $5,947 $4,535 $1,412 0.00
   7 to 12 827 $5,997 $4,758 $1,239 0.00
   13 to 18 749 $6,014 $5,159 $855 0.00
   19 to 24 574 $6,092 $5,229 $863 0.00
   25 to 30 418 $6,059 $5,434 $625 0.07
   31 to 36 280 $6,045 $5,271 $775 0.06
   37 to 42 146 $6,166 $5,908 $258 0.67
NOTE: The matched comparison group consists of HCBS waiver enrollees. Actual means for PACE enrollees are weighted by eligibility weights, defined as the number of months a beneficiary was alive and enrolled in PACE during each 6-month interval. Predicted means for PACE enrollees were obtained by first estimating a separate linear regression for each measurement period and outcome variable on the matched comparison group that controlled for demographics, chronic conditions, pre-enrollment Medicare service utilization and costs, months between the end of the pre-enrollment period and sample entry, indicator for any NH use in the 90 days prior to sample entry, and state indicators. The regressions incorporated the final weight for matched comparison group members obtained by multiplying the eligibility weights--defined as the number of months alive and not in managed care during each 6-month interval--with the propensity score matching weights. The estimated coefficients from these regressions were then used to predict expenditures for PACE enrollees in each interval, using the mean characteristics of the PACE sample in the equation. In some cases, the estimated effect is not exactly equal to the difference in means due to rounding.

 

TABLE 13. Regression-Adjusted Mean Mortality Rate for PACE and Matched Comparison Group Members Comprised of Both NH Entrants and HCBS Waiver Enrollees, by Group
(cumulative percentages)
  Deceased by End of:   Number of
  PACE Enrollees  
  Regression-Adjusted Mean  
for PACE Group
Number of Matched
  Comparison Group Enrollees  
Regression-Adjusted Mean
  for Matched Comparison Group  
  Estimated  
Effect
  p-value  
Month 6 3,725 4.36% 3,264 12.17% -7.81% 0.00
Month 12 3,725 9.17% 3,264 21.57% -12.40% 0.00
Month 18 3,725 13.81% 3,264 29.07% -15.26% 0.00
Month 24 3,725 18.44% 3,264 35.41% -16.96% 0.00
Month 30 3,725 23.47% 3,264 39.58% -16.10% 0.00
Month 36 3,725 28.86% 3,264 44.46% -15.59% 0.00
Month 42 3,073 33.02% 2,690 48.72% -15.70% 0.00
Month 48 2,313 36.84% 2,019 52.40% -15.56% 0.00
Month 54 1,553 40.85% 1,455 54.02% -13.17% 0.00
Month 60 844 42.73% 827 50.95% -8.21% 0.00
NOTE: The matched comparison group consists of both NH entrants and HCBS waiver enrollees. Regression-adjusted means were obtained from a separate logistic regression for each measurement period that controlled for demographics, chronic conditions, pre-enrollment Medicare service utilization and costs, months between the end of the pre-enrollment period and sample entry, indicator for any NH use in the 90 days prior to sample entry, and state indicators. For each regression, the entire matched sample was used for the first 6 intervals (since all sample members had at least 36 months of followup, with mortality data available through 2011), and the estimation sample in later intervals was restricted to those whose period of sample entry would allow us to observe their mortality in a particular interval. The predicted means are the cumulative mortality rate in each group, in each interval. Also, the regressions incorporate propensity score matching weights for the matched comparison group. In some cases, the estimated effect is not exactly equal to the difference in means due to rounding. We do not present results for the 11th interval (months 61-66) after enrollment due to the small sample sizes in both the treatment and matched comparison groups, which make the mortality estimates unreliable for that interval.

 

TABLE 14. Regression-Adjusted Mean Mortality Rate for PACE and Matched Comparison Group Members Comprised of HCBS Waiver Enrollees Alone, by Group
(cumulative percentages)
  Deceased by End of:   Number of
  PACE Enrollees  
  Regression-Adjusted Mean  
for PACE Group
Number of Matched
  Comparison Group Enrollees  
Regression-Adjusted Mean
  for Matched Comparison Group  
  Estimated  
Effect
  p-value  
Month 6 3,725 4.39% 2,745 6.09% -1.70% 0.00
Month 12 3,725 9.24% 2,745 13.02% -3.79% 0.00
Month 18 3,725 13.89% 2,745 18.77% -4.88% 0.00
Month 24 3,725 18.49% 2,745 24.61% -6.12% 0.00
Month 30 3,725 23.55% 2,745 29.43% -5.88% 0.00
Month 36 3,725 28.93% 2,745 33.71% -4.78% 0.00
Month 42 3,073 33.07% 2,245 38.82% -5.74% 0.00
Month 48 2,313 36.85% 1,804 42.02% -5.17% 0.00
Month 54 1,553 40.60% 1,323 42.67% -2.07% 0.20
Month 60 844 43.59% 895 44.19% -0.60% 0.78
NOTE: The matched comparison group consists of HCBS waiver enrollees only. Regression-adjusted means were obtained from a separate logistic regression for each measurement period that controlled for demographics, chronic conditions, pre-enrollment Medicare service utilization and costs, months between the end of the pre-enrollment period and sample entry, indicator for any NH use in the 90 days prior to sample entry, and state indicators. For each regression, the entire matched sample was used for the first 6 intervals (since all sample members had at least 36 months of followup, with mortality data available through 2011), and the estimation sample in later intervals was restricted to those whose period of sample entry would allow us to observe their mortality in a particular interval. The predicted means are the cumulative mortality rate in each group, in each interval. Also, the regressions incorporate propensity score matching weights for the matched comparison group. In some cases, the estimated effect is not exactly equal to the difference in means due to rounding. We do not present results for the 11th interval (months 61-66) after enrollment due to the small sample sizes in both the treatment and matched comparison groups, which make the mortality estimates unreliable for that interval.

 

TABLE 15. Estimated Effect of PACE on NH Utilization with Matched Comparison Group Members Comprised of HCBS Waiver Enrollees Alone
  Months from Entry   Number of
  PACE Enrollees  
  Regression-Adjusted Mean  
for PACE Group
Number of Matched
  Comparison Group Enrollees  
Regression-Adjusted Mean
  for Matched Comparison Group
  Estimated  
Effect
  p-value  
Any Nursing Home Use
   1 to 6 3,725 0.125 2,745 0.093 0.032 0.00
   7 to 12 3,277 0.151 2,481 0.107 0.044 0.00
   13 to 18 2,946 0.165 2,228 0.126 0.039 0.00
   19 to 24 2,187 0.166 1,653 0.131 0.035 0.00
   25 to 30 1,496 0.162 1,237 0.148 0.014 0.26
   31 to 36 911 0.142 854 0.144 -0.002 0.89
   37 to 42 441 0.112 591 0.113 -0.002 0.92
Proportion of Days in the Nursing Home
   1 to 6 3,725 0.027 2,745 0.022 0.005 0.03
   7 to 12 3,277 0.053 2,481 0.059 -0.006 0.26
   13 to 18 2,946 0.065 2,228 0.074 -0.009 0.14
   19 to 24 2,187 0.073 1,653 0.084 -0.011 0.15
   25 to 30 1,496 0.075 1,237 0.088 -0.013 0.14
   31 to 36 911 0.059 854 0.095 -0.036 0.00
   37 to 42 441 0.049 591 0.056 -0.007 0.58
At Least 30 Days in the Nursing Home
   1 to 6 3,561 0.049 2,590 0.041 0.008 0.13
   7 to 12 3,121 0.079 2,314 0.082 -0.003 0.67
   13 to 18 2,799 0.089 2,090 0.096 -0.007 0.35
   19 to 24 2,082 0.101 1,551 0.111 -0.010 0.31
   25 to 30 1,412 0.102 1,179 0.124 -0.022 0.06
   31 to 36 850 0.085 815 0.116 -0.032 0.02
   37 to 42 420 0.085 557 0.102 -0.017 0.37
At Least 90 Days in the Nursing Home
   1 to 6 3,561 0.017 2,590 0.016 0.001 0.69
   7 to 12 3,121 0.045 2,314 0.060 -0.015 0.01
   13 to 18 2,799 0.054 2,090 0.078 -0.024 0.00
   19 to 24 2,082 0.065 1,551 0.088 -0.023 0.01
   25 to 30 1,412 0.068 1,179 0.094 -0.027 0.01
   31 to 36 850 0.056 815 0.097 -0.041 0.00
   37 to 42 420 0.043 557 0.069 -0.026 0.10
NOTE: The matched comparison group consists of HCBS waiver enrollees only. Regression-adjusted means were obtained from a separate logistic regression (linear regression for proportion of days) for each measurement period that controlled for demographics, chronic conditions, pre-enrollment Medicare service utilization and costs, months between the end of the pre-enrollment period and sample entry, indicator for any NH use in the 90 days prior to sample entry, and state indicators. The outcomes--at least 30 or 90 days in the NH--were defined conditional on a beneficiary being alive during an interval. The regressions incorporate eligibility weights for PACE enrollees and eligibility weights multiplied with propensity score matching weights for the matched comparison group. In some cases, the estimated effect is not exactly equal to the difference in means due to rounding.

 

TABLE 16. Estimated Effect of PACE on NH Utilization, After Excluding New York, with Matched Comparison Group Members Comprised of HCBS Waiver Enrollees Alone
  Months from Entry   Number of
  PACE Enrollees  
  Regression-Adjusted Mean  
for PACE Group
Number of Matched
  Comparison Group Enrollees  
Regression-Adjusted Mean
  for Matched Comparison Group  
  Estimated  
Effect
  p-value  
Any Nursing Home Use
   1 to 6 2,773 0.152 1,905 0.113 0.040 0.00
   7 to 12 2,450 0.179 1,678 0.128 0.051 0.00
   13 to 18 2,197 0.202 1,477 0.152 0.050 0.00
   19 to 24 1,613 0.198 1,025 0.159 0.039 0.01
   25 to 30 1,078 0.194 701 0.190 0.004 0.81
   31 to 36 631 0.189 418 0.181 0.008 0.72
   37 to 42 295 0.157 203 0.158 0.000 0.99
Proportion of Days in the Nursing Home
   1 to 6 2,773 0.033 1,905 0.025 0.008 0.01
   7 to 12 2,450 0.061 1,678 0.071 -0.010 0.13
   13 to 18 2,197 0.078 1,477 0.088 -0.010 0.19
   19 to 24 1,613 0.084 1,025 0.106 -0.022 0.03
   25 to 30 1,078 0.090 701 0.112 -0.022 0.08
   31 to 36 631 0.076 418 0.129 -0.053 0.00
   37 to 42 295 0.067 203 0.074 -0.006 0.74
At Least 30 Days in the Nursing Home
   1 to 6 2,636 0.057 1,772 0.047 0.009 0.14
   7 to 12 2,319 0.089 1,538 0.098 -0.009 0.32
   13 to 18 2,090 0.106 1,373 0.117 -0.010 0.29
   19 to 24 1,530 0.119 948 0.140 -0.021 0.09
   25 to 30 1,009 0.119 663 0.162 -0.043 0.01
   31 to 36 586 0.107 395 0.151 -0.044 0.02
   37 to 42 278 0.125 186 0.130 -0.004 0.88
At Least 90 Days in the Nursing Home
   1 to 6 2,636 0.020 1,772 0.017 0.004 0.33
   7 to 12 2,319 0.051 1,538 0.072 -0.021 0.00
   13 to 18 2,090 0.064 1,373 0.092 -0.028 0.00
   19 to 24 1,530 0.076 948 0.112 -0.036 0.00
   25 to 30 1,009 0.082 663 0.121 -0.038 0.01
   31 to 36 586 0.072 395 0.129 -0.056 0.00
   37 to 42 278 0.067 186 0.076 -0.009 0.70
NOTE: The matched comparison group consists of HCBS waiver enrollees only. Regression-adjusted means were obtained from a separate logistic regression (linear regression for proportion of days) for each measurement period that controlled for demographics, chronic conditions, pre-enrollment Medicare service utilization and costs, months between the end of the pre-enrollment period and sample entry, indicator for any NH use in the 90 days prior to sample entry, and state indicators. The outcomes--at least 30 or 90 days in the NH--were defined conditional on a beneficiary being alive during an interval. The regressions incorporate eligibility weights for PACE enrollees and eligibility weights multiplied with propensity score matching weights for the matched comparison group. In some cases, the estimated effect is not exactly equal to the difference in means due to rounding.

 

TABLE 17. Estimated Effect of PACE on the Cumulative Risk of Being in a NH For At Least 90 Days with Matched Comparison Group Members Comprised of HCBS Waiver Enrollees Alone
  Months from Entry   Number of
  PACE Enrollees  
  Regression-Adjusted Mean  
for PACE Group
Number of Matched
  Comparison Group Enrollees  
Regression-Adjusted Mean
  for Matched Comparison Group  
  Estimated  
Effect
  p-value  
1 to 6 3,725 0.019 2,745 0.016 0.003 0.34
7 to 12 3,725 0.058 2,745 0.058 0.000 1.00
13 to 18 3,073 0.080 2,245 0.079 0.001 0.87
19 to 24 2,313 0.107 1,804 0.101 0.006 0.46
25 to 30 1,553 0.119 1,323 0.106 0.013 0.24
31 to 36 844 0.118 895 0.112 0.005 0.71
NOTE: The matched comparison group consists of HCBS waiver enrollees only. Regression-adjusted means were obtained from a separate logistic regression for each measurement period that controlled for demographics, chronic conditions, pre-enrollment Medicare service utilization and costs, months between the end of the pre-enrollment period and sample entry, indicator for any NH use in the 90 days prior to sample entry, and state indicators. For each regression, the entire matched sample was used for the first 2 intervals (since all sample members had at least 12 months of followup, with NH use data available through 2009), and the estimation sample in the later intervals was restricted to those whose period of sample entry would allow us to observe their NH use in those intervals. The predicted means are the cumulative risk of being in a NH for at least 90 days in each group, in each interval. The regressions incorporate propensity score matching weights for the matched comparison group. In some cases, the estimated effect is not exactly equal to the difference in means due to rounding. We do not present results for the 7th interval (months 37-42) after enrollment due to the small sample sizes in both the treatment and matched comparison groups, which make the estimates unreliable for that interval

 

TABLE 18. Estimated Effect of PACE on NH Utilization with Matched Comparison Group Members Comprised of Both NH Entrants and HCBS Waiver Enrollees
  Months from Entry   Number of
  PACE Enrollees  
  Regression-Adjusted Mean  
for PACE Group
Number of Matched
  Comparison Group Enrollees  
Regression-Adjusted Mean
  for Matched Comparison Group  
  Estimated  
Effect
  p-value  
Any Nursing Home Use
   1 to 6 3,725 0.126 3,264 0.592 -0.466 0.00
   7 to 12 3,277 0.153 2,736 0.449 -0.296 0.00
   13 to 18 2,946 0.166 2,363 0.425 -0.259 0.00
   19 to 24 2,187 0.166 1,690 0.401 -0.235 0.00
   25 to 30 1,496 0.162 1,166 0.387 -0.225 0.00
   31 to 36 911 0.142 807 0.355 -0.214 0.00
   37 to 42 441 0.105 483 0.252 -0.147 0.00
Proportion of Days in the Nursing Home
   1 to 6 3,725 0.028 3,264 0.308 -0.280 0.00
   7 to 12 3,277 0.053 2,736 0.354 -0.301 0.00
   13 to 18 2,946 0.064 2,363 0.327 -0.263 0.00
   19 to 24 2,187 0.070 1,690 0.286 -0.216 0.00
   25 to 30 1,496 0.070 1,166 0.266 -0.196 0.00
   31 to 36 911 0.051 807 0.235 -0.183 0.00
   37 to 42 441 0.034 483 0.146 -0.112 0.00
At Least 30 Days in the Nursing Home
   1 to 6 3,561 0.050 2,877 0.474 -0.424 0.00
   7 to 12 3,121 0.080 2,463 0.413 -0.332 0.00
   13 to 18 2,799 0.090 2,136 0.396 -0.307 0.00
   19 to 24 2,082 0.101 1,545 0.367 -0.266 0.00
   25 to 30 1,412 0.102 1,097 0.361 -0.259 0.00
   31 to 36 850 0.085 754 0.328 -0.244 0.00
   37 to 42 420 0.077 450 0.233 -0.156 0.00
At Least 90 Days in the Nursing Home
   1 to 6 3,561 0.018 2,877 0.328 -0.310 0.00
   7 to 12 3,121 0.046 2,463 0.374 -0.328 0.00
   13 to 18 2,799 0.055 2,136 0.349 -0.294 0.00
   19 to 24 2,082 0.065 1,545 0.305 -0.240 0.00
   25 to 30 1,412 0.067 1,097 0.286 -0.220 0.00
   31 to 36 850 0.057 754 0.268 -0.211 0.00
   37 to 42 420 0.037 450 0.170 -0.133 0.00
NOTE: The matched comparison group consists of both NH entrants and HCBS waiver enrollees. Regression-adjusted means were obtained from a separate logistic regression (linear regression for proportion of days) for each measurement period that controlled for demographics, chronic conditions, pre-enrollment Medicare service utilization and costs, months between the end of the pre-enrollment period and sample entry, indicator for any NH use in the 90 days prior to sample entry, and state indicators. The outcomes--at least 30 or 90 days in the NH--were defined conditional on a beneficiary being alive during an interval. The regressions incorporate eligibility weights for PACE enrollees and eligibility weights multiplied with propensity score matching weights for the matched comparison group. In some cases, the estimated effect is not exactly equal to the difference in means due to rounding.

 

TABLE 19. Estimated Effect of PACE on NH Utilization, After Excluding New York, with Matched Comparison Group Members Comprised of Both NH Entrants and HCBS Waiver Enrollees
  Months from Entry   Number of
  PACE Enrollees  
  Regression-Adjusted Mean  
for PACE Group
Number of Matched
  Comparison Group Enrollees  
Regression-Adjusted Mean
  for Matched Comparison Group  
  Estimated  
Effect
  p-value  
Any Nursing Home Use
   1 to 6 2,773 0.152 2,363 0.642 -0.490 0.00
   7 to 12 2,450 0.181 1,930 0.488 -0.307 0.00
   13 to 18 2,197 0.202 1,638 0.458 -0.256 0.00
   19 to 24 1,613 0.196 1,109 0.439 -0.242 0.00
   25 to 30 1,078 0.192 698 0.442 -0.250 0.00
   31 to 36 631 0.190 425 0.426 -0.236 0.00
   37 to 42 295 0.150 183 0.335 -0.186 0.00
Proportion of Days in the Nursing Home
   1 to 6 2,773 0.033 2,363 0.334 -0.301 0.00
   7 to 12 2,450 0.061 1,930 0.381 -0.320 0.00
   13 to 18 2,197 0.078 1,638 0.352 -0.274 0.00
   19 to 24 1,613 0.081 1,109 0.311 -0.230 0.00
   25 to 30 1,078 0.087 698 0.304 -0.217 0.00
   31 to 36 631 0.072 425 0.291 -0.219 0.00
   37 to 42 295 0.059 183 0.202 -0.143 0.00
At Least 30 Days in the Nursing Home
   1 to 6 2,636 0.057 2,046 0.512 -0.455 0.00
   7 to 12 2,319 0.090 1,705 0.447 -0.357 0.00
   13 to 18 2,090 0.106 1,461 0.426 -0.320 0.00
   19 to 24 1,530 0.118 999 0.406 -0.288 0.00
   25 to 30 1,009 0.118 649 0.414 -0.297 0.00
   31 to 36 586 0.107 393 0.395 -0.288 0.00
   37 to 42 278 0.110 163 0.309 -0.200 0.00
At Least 90 Days in the Nursing Home
   1 to 6 2,636 0.021 2,046 0.355 -0.334 0.00
   7 to 12 2,319 0.051 1,705 0.403 -0.352 0.00
   13 to 18 2,090 0.064 1,461 0.374 -0.310 0.00
   19 to 24 1,530 0.074 999 0.333 -0.259 0.00
   25 to 30 1,009 0.079 649 0.325 -0.246 0.00
   31 to 36 586 0.072 393 0.328 -0.257 0.00
   37 to 42 278 0.054 163 0.206 -0.152 0.00
NOTE: The matched comparison group consists of both NH entrants and HCBS waiver enrollees. Regression-adjusted means were obtained from a separate logistic regression (linear regression for proportion of days) for each measurement period that controlled for demographics, chronic conditions, pre-enrollment Medicare service utilization and costs, months between the end of the pre-enrollment period and sample entry, indicator for any NH use in the 90 days prior to sample entry, and state indicators. The outcomes--at least 30 or 90 days in the NH--were defined conditional on a beneficiary being alive during an interval. The regressions incorporate eligibility weights for PACE enrollees and eligibility weights multiplied with propensity score matching weights for the matched comparison group. In some cases, the estimated effect is not exactly equal to the difference in means due to rounding.

 

TABLE 20. Estimated Effect of PACE on the Cumulative Risk of Being in a NH For At Least 90 Days with Matched Comparison Group Members Comprised of Both NH Entrants and HCBS Waiver Enrollees
  Months from Entry   Number of
  PACE Enrollees  
  Regression-Adjusted Mean  
for PACE Group
Number of Matched
  Comparison Group Enrollees  
Regression-Adjusted Mean
  for Matched Comparison Group  
  Estimated  
Effect
  p-value  
1 to 6 3,725 0.020 3,264 0.304 -0.284 0.00
7 to 12 3,725 0.059 3,264 0.383 -0.324 0.00
13 to 18 3,073 0.082 2,690 0.397 -0.314 0.00
19 to 24 2,313 0.109 2,019 0.386 -0.277 0.00
25 to 30 1,553 0.123 1,455 0.371 -0.248 0.00
31 to 36 844 0.117 827 0.315 -0.198 0.00
NOTE: The matched comparison group consists of both NH entrants and HCBS waiver enrollees. Regression-adjusted means were obtained from a separate logistic regression for each measurement period that controlled for demographics, chronic conditions, pre-enrollment Medicare service utilization and costs, months between the end of the pre-enrollment period and sample entry, indicator for any NH use in the 90 days prior to sample entry, and state indicators. For each regression, the entire matched sample was used for the first 2 intervals (since all sample members had at least 12 months of followup, with NH use data available through 2009), and the estimation sample in the later intervals was restricted to those whose period of sample entry would allow us to observe their NH use in those intervals. The predicted means are the cumulative risk of being in a NH for at least 90 days in each group, in each interval. The regressions incorporate propensity score matching weights for the matched comparison group. In some cases, the estimated effect is not exactly equal to the difference in means due to rounding. We do not present results for the 7th interval (months 37-42) after enrollment due to the small sample sizes in both the treatment and matched comparison groups, which make the estimates unreliable for that interval.

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