Cost analysis of a home-based nurse care coordination program

Abstract

Objectives: To determine whether a home-based care coordination program focused on medication self-management would affect the cost of care to the Medicare program and whether the addition of technology, a medication-dispensing machine, would further reduce cost.

Design: Randomized, controlled, three-arm longitudinal study.

Setting: Participant homes in a large Midwestern urban area.

Participants: Older adults identified as having difficulty managing their medications at discharge from Medicare Home Health Care (N = 414).

Intervention: A team consisting of advanced practice nurses (APNs) and registered nurses (RNs) coordinated care for two groups: home-based nurse care coordination (NCC) plus a pill organizer group and NCC plus a medication-dispensing machine group.

Measurements: To measure cost, participant claims data from 2005 to 2011 were retrieved from Medicare Part A and B Standard Analytical Files.

Results: Ordinary least squares regression with covariate adjustment was used to estimate monthly dollar savings. Total Medicare costs were $447 per month lower in the NCC plus pill organizer group (P = .11) than in a control group that received usual care. For participants in the study at least 3 months, total Medicare costs were $491 lower per month in the NCC plus pill organizer group (P = .06) than in the control group. The cost of the NCC plus pill organizer intervention was $151 per month, yielding a net savings of $296 per month or $3,552 per year. The cost of the NCC plus medication-dispensing machine intervention was $251 per month, and total Medicare costs were $409 higher per month than in the NCC plus pill organizer group.

Conclusion: Nurse care coordination plus a pill organizer is a cost-effective intervention for frail elderly Medicare beneficiaries. The addition of the medication machine did not enhance the cost effectiveness of the intervention.

Keywords: care coordination; cost effectiveness; self-management.

Figure 1

The majority of participants were hospitalized before nursing home placement or death. Participants were followed for 2 months after hospitalization, rehabilitation, or nursing home placement and then discharged from the study. Examination of the claims data provided information on participants who died or were permanently placed in a nursing home after discharge from the study. NCC = nurse care coordination.