Professional agency vs consumer directed care workers: Outcomes in managed care

Area of Science:

• Health Services Research
• Gerontology
• Public Health Policy

Background:

• Direct care workers are essential for long-term services and supports (LTSS), representing a significant portion of healthcare spending in the United States.
• Two primary models for hiring direct care workers exist: professional agency models (PAMs) and consumer-directed models (CDMs), where individuals manage their own care.
• Understanding the cost and utilization differences between these models is crucial for optimizing LTSS delivery.

Purpose of the Study:

• To compare the cost and healthcare utilization outcomes between participants in PAMs and CDMs.
• To identify which model of direct care service delivery is more economically efficient for individuals receiving LTSS.

Main Methods:

• A retrospective observational cohort study using claims data from UPMC Community HealthChoices in Pennsylvania (2018).
• Analysis included 3,232 participants, comparing those in PAMs, CDMs, and a combination of services.
• Multivariate logistic regression was used for utilization outcomes, and linear regression for cost outcomes.

Main Results:

• Participants in CDMs were younger and had different demographic profiles compared to those in PAMs.
• Hospital utilization rates were consistent across both PAM and CDM groups.
• Total healthcare costs were significantly lower for participants in CDMs compared to PAMs, primarily due to differences in LTSS expenditures.

Conclusions:

• Consumer-directed models (CDMs) demonstrate greater cost-efficiency in delivering long-term services and supports (LTSS) compared to professional agency models (PAMs).
• Despite demographic and health need differences, CDM participants incurred lower overall costs without compromising hospital utilization.
• These findings support the value of CDMs for policymakers and insurers aiming to balance cost-effectiveness with individual autonomy in LTSS.