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Professional agency vs consumer directed care workers: Outcomes in managed care
Health and Social Care in the Community ( IF 2.395 ) Pub Date : 2021-07-26 , DOI: 10.1111/hsc.13488
Clark A. Veet 1 , Mary E. Winger 2 , Suzanne M. Kinsky 2
Affiliation  

Direct care workers are a major part of the long-term services and supports (LTSS) needed to address the health of individuals and accounted for $112 billion in United States spending in 2015. Direct care workers are hired within professional agency models (PAMs) or consumer-directed models (CDMs) where workers (including family) are contracted by the individual to obtain services. We sought to identify differences in cost and utilisation outcomes between PAM and CDM participants. Data were obtained from the University of Pittsburgh Medical Center (UPMC) Insurance Services Division from the participants enrolled in UPMC Community HealthChoices in Pennsylvania during 2018. A retrospective, observational cohort study design was performed using claims data. Utilisation outcomes were assessed using multivariate logistic regression and cost outcomes by linear regression. The 3,232 participants met the inclusion criteria. Of these, 69% (N = 2,217) were in a PAM, 23% (N = 752) were in a CDM, and 8% (N = 263) used a combination of services. PAM groups were older (mean 62.4 years vs 54.1 years), more likely to be women (69.0% vs 62.8%), and had more healthcare needs. Hospital utilisation was the same among groups. However, total cost was lower in CDM groups due to differences in LTSS costs between CDM and PAM services. Among dually eligible Medicare and Medicaid beneficiaries receiving LTSS, there are significant differences in age, gender, race and health needs. While hospital utilisation was not different between groups, CDM groups had lower total costs of care compared to PAM. These findings have implications for families, policymakers and insurers in helping to govern community LTSS while supporting member autonomy.

中文翻译:

专业机构与消费者导向的护理人员:管理式护理的结果

直接护理人员是解决个人健康问题所需的长期服务和支持 (LTSS) 的主要组成部分,在 2015 年占美国支出的 1120 亿美元。直接护理人员受雇于专业机构模式 (PAM) 或以消费者为导向的模式 (CDM),其中工人(包括家庭)与个人签订合同以获得服务。我们试图确定 PAM 和 CDM 参与者之间成本和利用结果的差异。数据来自匹兹堡大学医学中心 (UPMC) 保险服务部,来自 2018 年参加宾夕法尼亚州 UPMC Community HealthChoices 的参与者。使用索赔数据进行回顾性观察性队列研究设计。使用结果使用多元逻辑回归和成本结果通过线性回归进行评估。3,232 名参与者符合纳入标准。其中,69%(N  = 2,217) 在 PAM 中,23% ( N  = 752) 在 CDM 中,8% ( N = 263) 使用了服务组合。PAM 组年龄更大(平均 62.4 岁对 54.1 岁),更有可能是女性(69.0% 对 62.8%),并且有更多的医疗保健需求。各组的医院利用率相同。然而,由于 CDM 和 PAM 服务之间的 LTSS 成本存在差异,CDM 组的总成本较低。在接受 LTSS 的双重合格医疗保险和医疗补助受益人中,年龄、性别、种族和健康需求存在显着差异。虽然各组之间的医院利用率没有差异,但与 PAM 相比,CDM 组的总护理成本较低。这些发现对家庭、政策制定者和保险公司在帮助管理社区 LTSS 同时支持成员自治方面产生了影响。
更新日期:2021-07-26
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