TY - JOUR
T1 - What's Happening at Home
T2 - A Claims-based Approach to Better Understand Home Clinical Care Received by Older Adults
AU - Harrison, Krista L.
AU - Leff, Bruce
AU - Altan, Aylin
AU - Dunning, Stephan
AU - Patterson, Casey R.
AU - Ritchie, Christine S.
N1 - Funding Information:
Analyses were conducted by OptumLabs using funding from AARP. During the conduct of this study, K.L.H. was supported in part by funding from an Aging Research Fellowship from the National Institute of Aging (T32AG000212); Atlantic Fellowship of the Global Brain Health Institute; UCSF Hellman Fellows Award; UCSF Claude D. Pepper Older Americans Independence Center funded by National Institute on Aging (P30 AG044281); Career Development Award from the National Center for Advancing Translational Sciences of the NIH (KL2TR001870); National Palliative Care Research Center Junior Faculty Award; and National Institute of Aging Mentored Research Scientist Development Award (K01AG059831).
Publisher Copyright:
© 2020 Lippincott Williams and Wilkins. All rights reserved.
PY - 2020/4/1
Y1 - 2020/4/1
N2 - Background:Home clinical care (HCC) includes home-based medical care (HBMC-medical visits in the home) and skilled home health care (skilled nursing or therapy visits). Over 7 million older adults would benefit from HCC; however, we know surprisingly little about homebound older adults and HCC.Objective:To describe HCC received by older adults using claims data within the OptumLabs Data Warehouse.Research Design:Using administrative claims data for commercial and Medicare Advantage enrollees, we describe morbidity profiles, health service use, and care coordination (operationalized as care plan oversight [CPO]) for people receiving HCC and the subgroup receiving HBMC.Participants:Three million adults (3,027,247) age ≥65 with 12 months of continuous enrollment 2013-2014.Measures:CPT or HCPCS codes delineated HCC, HBMC, and CPO recipients and care site, frequency, and provider type. Other measures included demographic characteristics, clinical characteristics, and health care utilization.Results:Overall, 5% of the study population (n=161,801) received 2+ months of HCC visits; of these, 46% also received 2+ HBMC visits (n=73,638) while 54% received only skilled home health (n=88,163 HCC but no HBMC). HBMC-recipients had high comorbidity burden (Charlson score 4.3), dementia (35%), and ambulance trips (58%), but few nursing facility admissions (4.9%). Evidence of care coordination (CPO claims) occurred in 30% of the HCC population, 46% of HBMC, and 17% of the skilled home health care only.Conclusions:Approximately 1 of 20 older adults in this study received HCC; 30% or less have a claim for care coordination by their primary care provider.
AB - Background:Home clinical care (HCC) includes home-based medical care (HBMC-medical visits in the home) and skilled home health care (skilled nursing or therapy visits). Over 7 million older adults would benefit from HCC; however, we know surprisingly little about homebound older adults and HCC.Objective:To describe HCC received by older adults using claims data within the OptumLabs Data Warehouse.Research Design:Using administrative claims data for commercial and Medicare Advantage enrollees, we describe morbidity profiles, health service use, and care coordination (operationalized as care plan oversight [CPO]) for people receiving HCC and the subgroup receiving HBMC.Participants:Three million adults (3,027,247) age ≥65 with 12 months of continuous enrollment 2013-2014.Measures:CPT or HCPCS codes delineated HCC, HBMC, and CPO recipients and care site, frequency, and provider type. Other measures included demographic characteristics, clinical characteristics, and health care utilization.Results:Overall, 5% of the study population (n=161,801) received 2+ months of HCC visits; of these, 46% also received 2+ HBMC visits (n=73,638) while 54% received only skilled home health (n=88,163 HCC but no HBMC). HBMC-recipients had high comorbidity burden (Charlson score 4.3), dementia (35%), and ambulance trips (58%), but few nursing facility admissions (4.9%). Evidence of care coordination (CPO claims) occurred in 30% of the HCC population, 46% of HBMC, and 17% of the skilled home health care only.Conclusions:Approximately 1 of 20 older adults in this study received HCC; 30% or less have a claim for care coordination by their primary care provider.
KW - aging/elderly/geriatrics
KW - claims data
KW - home clinical care
KW - home-based medical care
KW - home-limited
KW - homebound
KW - housecalls
KW - palliative care
UR - http://www.scopus.com/inward/record.url?scp=85081944288&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85081944288&partnerID=8YFLogxK
U2 - 10.1097/MLR.0000000000001267
DO - 10.1097/MLR.0000000000001267
M3 - Article
C2 - 31876645
AN - SCOPUS:85081944288
SN - 0025-7079
VL - 58
SP - 360
EP - 367
JO - Medical care
JF - Medical care
IS - 4
ER -