By Geralyn Magan
A Cityscape article details how RTI International and the LTSS Center measured the impact of Vermont’s Support and Services at Home (SASH) program.
An article in the latest issue of the journal Cityscape describes research showing that Support and Services and Home (SASH), a housing plus services program in Vermont, slowed growth in total Medicare expenditures for some of its participants.
Robyn Stone and Alisha Sanders of the LeadingAge LTSS Center @UMass Boston co-authored “The Impact of the Vermont Support and Services at Home Program on Healthcare Expenditures” along with research colleagues from RTI International and the University of North Carolina at Greensboro.
Cathedral Square Corporation (CSC), a LeadingAge member in Burlington, VT, launched SASH in 2011. The program is designed to help SASH participants living in or near affordable senior housing communities access the health care and support services they need to remain healthy and independent. Most SASH participants live in housing communities assisted by the U.S. Department of Housing and Urban Development (HUD) or the Low-Income Housing Tax Credit (LIHTC) program.
HOW SASH WORKS
SASH features an onsite team consisting of a full-time SASH coordinator and a quarter-time SASH wellness nurse. Each SASH team works to promote greater care coordination for panels of approximately 100 SASH participants. Those teams:
- Complete an assessment of newly enrolled SASH participants to determine their health conditions, medications, social circumstances, and the support services they currently use or need.
- Use the assessment, which is updated each year, to identify the health and service needs of individuals and to provide group programming that addresses common needs.
- Work with local service provider organizations to connect SASH participants with resources in the community.
- Work with the participants’ health care providers to ensure proper medication usage, successful hospital discharges, and overall coordination and continuity of care.
Since its launch at CSC, SASH has grown into a statewide initiative that, in December 2016, included 54 panels throughout Vermont. CSC continues to coordinate program expansion and training at the state level, while 6 Designated Regional Housing Organizations oversee the SASH program in their geographic regions. During the course of the evaluation, SASH was supported by a Medicare demonstration and funding from the State of Vermont. These funds leveraged existing HUD and LIHTC funding for service coordinators. After the Medicare demonstration ended, the State of Vermont entered into an all-payer waiver with Centers for Medicare & Medicaid Services, through which SASH continues to receive Medicare support.
SASH programs are currently available in 138 affordable housing sites and surrounding communities. These programs are operated or hosted by 22 housing organizations.
FINDINGS FROM THE EVALUATION
The Cityscape article details the process that RTI and LTSS Center researchers used to measure SASH’s impact on participants’ Medicare expenditures during the program’s first 5.5 years.
During the evaluation, researchers examined total Medicare costs and many subcategories of Medicare costs to determine any shifts in health care utilization. They compared those changes in expenditures among the SASH participants with changes in expenditures for a comparison group of Medicare beneficiaries living in HUD-assisted or LIHTC communities that did not host the SASH program. Researchers also surveyed SASH participants and interviewed SASH staff, stakeholders, and community partners.
The evaluation did not find that the SASH program had a significant impact on Medicare expenditures for all participants in the study’s sample. But it did find that SASH reduced Medicare expenditures for certain participants.
“For a subset of the SASH panels, namely those under the direction of CSC and those in (urban) Chittenden County, Medicare cost growth was significantly slower relative to the comparison group,” write the authors. “Favorable impacts of the SASH program were particularly pronounced for dual-eligible participants.”
Among urban panels, researchers found that the SASH program is associated with a $122.24 per-beneficiary-per-month (PBPM) lower growth in total Medicare expenditures. Most of this lower cost growth is driven by a $70.64 PBPM lower growth in acute care costs. No significant favorable impacts were found on the Medicare expenditures of participants in the rural panels.
The favorable results were most prominent in a subset of SASH panels that researchers say contained nearly half of the SASH participants in HUD-assisted or LIHTC communities. This finding, write the authors, “provides evidence that a housing plus services model has the potential to slow the growth of health care costs.”
ADDITIONAL RESEARCH
The authors conclude their Cityscape article by pointing out that the SASH program has other potential benefits, in addition to bending the Medicare cost curve. For example, researchers found that SASH participants had higher self-reported physical function scores and less difficulty with medication management.
“Continuing research efforts should delve further into identifying the characteristics of care coordination initiatives in an affordable housing setting that are associated with achieving favorable outcomes for participants,” they write.