Performance Improvement 2007. How Do Integrated Care Programs for the Frail Elderly Use Community-Based Primary Care Physicians?

01/01/2007

Summary:

This was the most recent of several studies leading up to a final report evaluating the "Program of All-Inclusive Care for the Elderly" (PACE) that will be released at a later date. PACE is an innovative model that seeks positive outcomes and cost savings by providing a range of integrated preventative, acute care, and long-term care services to manage the often complex medical, functional, and social needs of frail elderly individuals. The over-all study is examining the expected quality and cost of providing PACE program services under the Medicare and Medicaid programs when it is operated as a permanent (as opposed to a demonstration) program. The study is also comparing the cost, quality, and access to services provided by private, for-profit entities operating under demonstration project waivers with the costs, quality, and access to services of public and not-for-profit providers. This project seeks to expand the understanding gained in previous evaluations of PACE by predicting costs beyond the first year of enrollment, assessing the impact of higher end-of-life costs and long term nursing home care, and assessing the impact of local treatment practices.

The current study examined how three programs, in California, New York, and Wisconsin, used physicians. The studies included site visits to the local programs and interviews of participants. None of the sites preferred working with community-based physicians; they considered this a way to get care to more people who need their services. To counteract the concern that community-based physicians would not communicate with or work as well with the PACE team as PACE physicians do, and thus cause the program to not be able to care as effectively for its patients, programs at the three sites had implemented ways that, based on staff's perception, addressed these concerns.

Report Title: How Integrated Care Programs Use Community-Based Primary Care Physicians http://www.cms.hhs.gov/reports/downloads/cheh.pdf
Agency Sponsor: CMS, Centers for Medicare and Medicaid Services
Federal Contact: Thomas, Fred G., 410-786-6675
Performer: Mathematica Policy Research, Inc.; Princeton, NJ
PIC ID: 7667

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