Studying Systems for Chronic and Postacute Care

Home Health | Case Management | Long-Term Care | Disabilities | AIDS

Longer life expectancy, better care for acute illness, more ways to save victims of serious accidents, and changes in health service financing have dramatically increased the demand for chronic and postacute care. This trend will continue as baby boomers join the ranks of the elderly and the very old. Mathematica Policy Research is a leader in studying cost-effective ways to deliver services that meet people’s health care needs after hospitalization. We have also studied how service delivery can increase the independence and improve the health of people with disabilities.

Medicare Home Health Care

During the past 10 years, expenditures for the Medicare home health benefit have grown rapidly and out of proportion relative to growth in other Medicare services. We have helped the Centers for Medicare & Medicaid Services (CMS) test several prospective financing mechanisms to rein in home health costs while ensuring that beneficiaries have access to the high-quality care they need.

High-Cost Case Management

A small proportion of Medicare beneficiaries account for a large proportion of Medicare spending. Furthermore, more than half this spending goes for inpatient hospital care. In a national demonstration, we are evaluating whether case management for beneficiaries with chronic illnesses and complex treatment regimens improves their health and reduces unnecessary hospitalizations.

Long-Term Care

By the year 2030, 42 million Americans will be living with chronic conditions that limit their ability to perform everyday activities. Beginning with our groundbreaking national evaluation of the Long-Term Care Channeling Demonstration in the early 1980s, we have a long history of investigating how to deliver services so that people with disabilities can maintain independence and dignity in their daily lives. We continue to evaluate new models, such as social HMOs and the Program of All-Inclusive Care for the Elderly (PACE), which integrates preventive, acute, and long-term care.

Medicaid Coverage for People with Disabilities

To examine the health care use, costs, and adequacy of care that disabled and special needs populations receive under Medicaid, we are building a database linking Medicaid eligibility and claims information with Supplemental Security Income (SSI) eligibility records maintained by the Social Security Administration. We are also examining different methods of financing home- and community-based care for people with disabilities who are enrolled in the Medicaid program. The traditional model has been to assign case managers to coordinate care and supervise personal assistance services. We are evaluating an alternative model in which Medicaid beneficiaries are given a monthly cash allowance to meet their long-term care needs as they see fit, as well as counseling to support their efforts to do so.

Services for People with AIDS

Once strictly an acute and fatal disease, AIDS has become a complex chronic illness as a result of better health care and new pharmaceutical treatments. The disease is growing among poor people of color as well as people with substance abuse and mental health problems. We have helped major funders of AIDS services, including CMS and the Health Resources and Services Administration, assess how well the service delivery system meets the multifaceted needs of people living with AIDS.

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