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Related Experiment Videos

Disenrollment from an acute/long-term managed care program (PACE).

Helena Temkin-Greener1, Alina Bajorska, Dana B Mukamel

  • 1Department of Community and Preventive Medicine, University of Rochester School of Medicine, Rochester, New York 14642, USA. Helena_Greener@urmc.rochester.edu

Medical Care
|December 21, 2005
PubMed
Summary
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Disenrollment from the Program of All-Inclusive Care for the Elderly (PACE) is low, with no increased risk for vulnerable populations. However, factors like hospital admissions and private pay status increase disenrollment risk, indicating a need for quality improvements.

Area of Science:

  • Gerontology
  • Health Services Research
  • Managed Care

Background:

  • The Program of All-Inclusive Care for the Elderly (PACE) serves frail Medicare beneficiaries.
  • Existing research lacks examination of PACE disenrollment patterns and predictors.

Purpose of the Study:

  • To investigate disenrollment patterns and predictors within the PACE program.
  • To determine if PACE achieves low exit rates and minimal selective disenrollment.

Main Methods:

  • Analysis of individual-level data from 14,657 participants across 30 PACE programs.
  • Utilized Cox proportional hazard models with time-varying and invariant covariates.
  • Included sociodemographic, caregiver, health status, medical history, and service utilization data.

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Main Results:

  • Overall low disenrollment rates observed.
  • No increased disenrollment risk associated with age, functional/cognitive impairment, Medicaid eligibility, or diagnoses.
  • Nursing treatments reduced disenrollment hazard; hospital admissions and private pay status increased it.
  • Disenrollment risk rose with nursing home stays up to 80-90 days, then declined.

Conclusions:

  • Both enrollee and program characteristics predict disenrollment.
  • Programmatic and quality of care enhancements are necessary to further reduce disenrollment.
  • Targeted improvements are crucial for programs with higher-than-average disenrollment rates.