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Cost analysis of a home-based nurse care coordination program.
Karen Dorman Marek1, Frank Stetzer, Scott J Adams
1College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona.
Journal of the American Geriatrics Society
|December 9, 2014
Summary
Home-based nurse care coordination with a pill organizer significantly reduced Medicare costs for elderly patients. Adding a medication-dispensing machine did not improve cost-effectiveness.
Area of Science:
- Gerontology
- Health Services Research
- Health Economics
Background:
- Medication self-management is a challenge for older adults transitioning from Medicare Home Health Care.
- Effective care coordination programs are needed to reduce healthcare costs for this population.
Purpose of the Study:
- To evaluate the cost-effectiveness of a home-based nurse care coordination (NCC) program for medication self-management.
- To determine if incorporating a medication-dispensing machine enhances cost savings compared to a pill organizer.
Main Methods:
- A randomized, controlled, three-arm longitudinal study involving 414 older adults with medication management difficulties.
- Interventions included usual care, NCC with a pill organizer, and NCC with a medication-dispensing machine.
- Medicare Part A and B claims data from 2005-2011 were analyzed to estimate costs.
Main Results:
- The NCC plus pill organizer group showed a monthly Medicare cost reduction of $447 (P = .11), with a net savings of $296/month ($3,552/year) after intervention costs.
- For participants in the study for at least 3 months, Medicare costs decreased by $491/month (P = .06) in the NCC plus pill organizer group.
- The NCC plus medication-dispensing machine intervention resulted in $409 higher monthly Medicare costs compared to the NCC plus pill organizer group.
Conclusions:
- Home-based nurse care coordination combined with a pill organizer is a cost-effective intervention for frail elderly Medicare beneficiaries.
- The addition of a medication-dispensing machine did not improve the cost-effectiveness of the care coordination program.
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