Targeted use of agencies for personal care services: analysis of a health plan’s natural experiment

Targeted use of agencies for personal care services: analysis of a health plan’s natural experiment

Collection:
Health Policy and Services Research
Author(s):
Hwang, Ann, author
Contributor(s):
California HealthCare Foundation, issuing body.
Publication:
[Oakland, CA] : California Health Care Foundation, July 2023
Language(s):
English
Format:
Text
Subject(s):
Aged
Delivery of Health Care
Persons with Disabilities
Dual MEDICAID MEDICARE Eligibility
Health Services for the Aged
Home Care Services
Medicaid
Medicare
Patient-Centered Care
State Health Plans
California
Genre(s):
Technical Report
Abstract:
CalAIM (California Advancing and Innovating Medi-Cal) and other initiatives to advance care for Medi-Cal enrollees present an important opportunity to improve the personal care services that help older adults and people with disabilities remain in their homes and communities. For over a half million Medi-Cal enrollees who need help with activities of daily living, personal care services are essential for health, well-being, and independence. However, ultimately, the effectiveness of these personal care services hinges on an individual’s ability to secure and retain a reliable provider - which is difficult for many. In California, most personal care services are delivered through the In-Home Supportive Services (IHSS) Program. While most IHSS care recipients do successfully hire an independent provider (often a family member or friend), many people who need help at home struggle to find a reliable person to help them. While the vast majority of IHSS recipients find, hire, and manage their own provider - a core and unique feature of the program’s design since its inception - IHSS can also be provided through an agency that employs IHSS providers and connects them to care recipients. This delivery model is known as contract mode IHSS. However, access to contract mode IHSS is very limited, with only one county in California currently offering this option. This report describes findings from an analysis of the experiences of a small group of high-need, high-cost Medi-Cal enrollees in San Mateo County who were receiving contract mode IHSS but then lost access due to policy changes. In this group, the discontinuation of contract mode IHSS was associated with higher per-member use of institutional long-term care, and more inpatient admissions. These developments translated to higher spending on selected categories of medical services and long-term services and supports. This small observational study affirms the importance of personal care services and demonstrates how disruptive changes to the provision of that care can be for Medi-Cal enrollees. Medi-Cal stakeholders should thus plan carefully for any changes that impact the provision of personal care services, particularly changes that decrease or limit existing options. Importantly, this study suggests that although contract mode may be a more expensive model for delivering IHSS, in this selected population it may be associated with lower overall costs due to lower utilization of institutional long-term care and lower rates of hospitalization. More broadly, in the context of CalAIM, these findings suggest that agency-mediated personal care services could play an important role as a cost-effective alternative to institutional long-term care. Given these findings and the critical role personal care services play in keeping people in their homes and communities, Medi-Cal stakeholders should consider opportunities and policies to strengthen access to these services, through all modes of delivery, for all consumers who need them.
Copyright:
Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY-NC-ND license. (More information)
Extent:
1 online resource (1 PDF file (19 pages))
Illustrations:
Illustrations
NLM Unique ID:
9918734178506676 (See catalog record)
Permanent Link:
http://resource.nlm.nih.gov/9918734178506676