More for Less in Long-Term Home Care Services: Titrating Payment to Risk, Value and Effectiveness

Publication Date: October 2001

Publisher: Center for Home Care Policy and Research, Visiting Nurse Service of New York; Robert Wood Johnson Foundation

Author(s): W.G. Weissert

Research Area: Health

Type: Report

Abstract:

The author begins this policy brief by pointing to research that found when access to government-subsidized home care is expanded, most clients who seek home care are at low risk of needing nursing home care. Therefore, a problem exists when people who would not have used institutional care now request home care: the total number of users of health care increase and costs rise. The author notes that this is a significant public policy consideration and that it is important to determine whether there might be a system in which Medicaid funds could be reallocated to more appropriately and cost-efficiently meet individuals' service needs.

The author proposes a “titrating” system as an alternative payment system for home care, in which the amount of home care an individual receives is adjusted to the risk the individual faces and also reflects the value of the outcomes to be achieved. Under the proposed system, case managers would have a risk profile and a budget for each client and the goal would be to mitigate high-risk outcomes within individual budgets. Using his proposed method, the author compared actual spending in the current program with the associated calculated risks. His findings indicated that low-risk individuals may get twice as much care as they should while those he would consider high risk got half as much as they needed.

The titrating system, the author concludes, would likely result in better outcomes without an increase in total spending.