Papers by Robert Newcomer
Medical Care, 2016
Individuals who receive long-term services and supports (LTSS) are among the most costly particip... more Individuals who receive long-term services and supports (LTSS) are among the most costly participants in the Medicare and Medicaid programs. To compare health care expenditures among users of Medicaid home and community-based services (HCBS) versus those using extended nursing facility care. Retrospective cohort analysis of California dually eligible adult Medicaid and Medicare beneficiaries who initiated Medicaid LTSS, identified as HCBS or extended nursing facility care, in 2006 or 2007. Propensity score matching for demographic, health, and functional characteristics resulted in a subsample of 34,660 users who initiated Medicaid HCBS versus extended nursing facility use. Those with developmental disabilities or in managed care plans were excluded. Average monthly adjusted acute, postacute, long-term, and total Medicare and Medicaid expenditures for the 12 months following initiation of either HCBS or extended nursing facility care. Those initiating extended nursing facility care had, on average, $2919 higher adjusted total health care expenditures per month compared with those who initiated HCBS. The difference was primarily attributable to spending on LTSS $2855. On average, the monthly LTSS expenditures were higher for Medicare $1501 and for Medicaid $1344 when LTSS was provided in a nursing facility rather than in the community. The higher cost of delivering LTSS in a nursing facility rather than in the community was not offset by lower acute and postacute spending. Medicare and Medicaid contribute similar amounts to the LTSS cost difference and both could benefit financially by redirecting care from institutions to the community.
Health care financing review
Health care financing review
Evaluating the performance of long-term care (LTC) demonstrations requires longitudinal assessmen... more Evaluating the performance of long-term care (LTC) demonstrations requires longitudinal assessment of multiple outcomes where selective mortality and disenrollment, if not accounted for, can give the appearance of reduced (or enhanced) efficacy. We assessed outcomes in social/health maintenance organizations (S/HMOs) and Medicare fee-for-service (FFS) care using a multivariate model to estimate active life expectancy (ALE). S/HMO enrollees and samples of FFS clients in four sites were analyzed and outcome differences assessed for a 3-year period. Results provide insights into S/HMO performance under different conditions and, more generally, into evaluating LTC demonstrations without randomized client and control groups.
Health care financing review
Simulation analyses quantify admission and continuing physical and cognitive i m p a i r ment pat... more Simulation analyses quantify admission and continuing physical and cognitive i m p a i r ment patient case-mix changes under two scenarios: with increases in r e s idential care supply and with all nursing homes licensed only as skilled care facilities. Findings raise caution about the assumed interplay between residential care supply and nursing home use. The pr o p o rtion of nursing home patients with only physical and cognitive impairment likely to be af fected by current and emerging longt e rm care (LTC) policy was well under 25 p e rcent of the nursing home population in each of the four study States. States varied in LTC supply and utilization contro l s .
... mission is to expand access to affordable, quality health care ... 3 Regulations and QualityA... more ... mission is to expand access to affordable, quality health care ... 3 Regulations and QualityAssurance .....3 ... 22 RCF Residents .....25 Housing and Residential ...
Journal of the American Geriatrics Society, 2000
ABSTRACT
Journal of the American Geriatrics Society, 1999
Medicare claims as the basis for health condition adjustments is becoming a method of choice in c... more Medicare claims as the basis for health condition adjustments is becoming a method of choice in capitation reimbursement. A recent study has found that claims-based beneficiary classification for Alzheimer's disease produces lower prevalence estimates and higher average costs than previous healthcare cost studies in this population. These sets of studies differ in data sources, period length, and in their specification of dementia. Participants in the Medicare Alzheimer's Disease Demonstration (MADDE) provide a sample of persons known to have some form of dementia. This group is used to test the adequacy of claims data for identifying eligible cases and any bias in expenditure differences between those flagged or not flagged by a claim in a given period. A prospective cohort design using up to 36 months of claims data. The demonstration enrolled 4166 participants in treatment, and 3942 in a control group in eight communities across the US. Cases were combined in this analysi...
Journal of the American Geriatrics Society, 1997
1. J Am Geriatr Soc. 1997 Jan;45(1):101-7. S/HMOs, the second generation: building on the experie... more 1. J Am Geriatr Soc. 1997 Jan;45(1):101-7. S/HMOs, the second generation: building on the experience of the first Social Health Maintenance Organization demonstrations. Kane RL, Kane RA, Finch M, Harrington C, Newcomer R, Miller N, Hulbert M. ...
Lippincott's Case Management, 2005
Consistency and communication remain key barriers to tracking case management outcomes and develo... more Consistency and communication remain key barriers to tracking case management outcomes and developing the best practices. A dictionary of case management problems, goals, interventions, and outcomes was developed to support a prevention-oriented case management program targeted on elderly high-risk patients. Case management featured an annual screening questionnaire, appointment monitoring, disease education, self-management support, and ongoing care coordination. The dictionary resulted in a Standardized Language for Case Management (SLED). This has since been reviewed and modified on the basis of comments and recommendations from 5 leading case management organizations and is aligned with Standards of Practice for Case Management. The article provides a description of the standardized language terms, the rationale underlying the documentation, examples of how this dictionary of definitions can be incorporated into the daily practice of case management, and examples of some of the benefits to the field that can be achieved with the use of a common data-recording system.
Journal of Disability Policy Studies, 2002
About one fifth of the adult population with disabilities living in the community moved during a ... more About one fifth of the adult population with disabilities living in the community moved during a 12-to 24-month period between 1994 and 1996. This article examines the extent to which the ability to perform activities of daily living (ADL) and instrumental activities of daily living (IADL) was associated with these moves. Data are from the 1994-1995 National Health Interview Survey
Professional Case Management, 2007
This article reviews 15 clinical trials of nurse-assisted case management intended to improve pos... more This article reviews 15 clinical trials of nurse-assisted case management intended to improve posthospital transitions of elderly patients to other settings. Hospitals. The trials were selected after a systematic search of the PubMed database for the period 1996 to 2006. Eight of the 15 interventions showed reduced hospital readmission rates and/or fewer hospital days. These findings were observed across patients with "all cause" and heart failure, a variety of hospital types, and variations in the intervention. Reductions in the use of emergency departments were observed in 3 of the 11 studies investigating this. Lower expenditures were reported by all 6 studies reporting such comparisons. Home visits/continuous contact with patients, early postdischarge and frequent contacts, patient education, and the use of specialized nurses who could offer appropriate training and coaching were often credited as program strengths.
Journal of Housing For the Elderly, 2001
... Robert Newcomer James Swan Sarita L. Karon SUMMARY. An evolution is occurring in statepolicy ... more ... Robert Newcomer James Swan Sarita L. Karon SUMMARY. An evolution is occurring in statepolicy and industry practices relative to assisted living and expanded use of residential care facilities (RCFs) for persons with physical and cognitive frailty, yet rela-tively little is known ...
The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 2005
This study used a person-environment (P-E) framework to examine individual capabilities and socia... more This study used a person-environment (P-E) framework to examine individual capabilities and social and physical environmental attributes for their association with unmet assistance needs in activities of daily living (ADLs). Analyses were replicated among five ADLs (bathing, dressing, transferring, toileting, eating) and test the relative risk of apartment dwellers compared to those living in houses. Data were obtained from the National Health Interview Survey, Supplement on Disability Followback Survey. Analyses consisted of a nationally representative sample of aged and nonaged adults with one or more ADL limitations. Slightly less than 1 in 5 subjects with a specific ADL limitation had unmet needs for that ADL. This was true across all ADLs. The likelihood of unmet ADL assistance increased with the number of ADL limitations and other health status indicators. It was at least 50% higher among those living in apartments than in houses and higher among Hispanics. There were no differences by age or gender. The P-E framework postulates that individuals seek settings matched to their capabilities, but findings suggest that many are at risk for adaptation at any one time. Specific risk factors are identified. Selection factors like preferences, expectations, and adaptation options available have not been directly measured.
Journal of Aging and Health, 1996
We compared the prior and current costs of persons age 65 and older enrolling in a Social/Health ... more We compared the prior and current costs of persons age 65 and older enrolling in a Social/Health Maintenance Organization in each of four sites with samples of persons using standard Medicare benefits in each site. Analyses were adjusted for individual health differences using case mix scores. Costs were examined in the year before S/HMO enrollment or prior to the sampling of a person using regular Medicare services as well as costs during the study. Costs during the study are analyzed using a two-stage procedure where first the propensity to enroll in a S/HMO is modeled and then costs derived from either Medicare sources or shadow prices assigned to service units provided in a S/HMO are modeled. The costs for case mix groups with different health and functional characteristics varied significantly. Cost differences between case mix classes differed between the S/HMO and FFS populations.
The Gerontologist, 2003
Purpose: The purpose of this study was to identify reliable predictors of nursing home entry over... more Purpose: The purpose of this study was to identify reliable predictors of nursing home entry over a 3year period in a sample of 3,944 persons with dementia who resided in a home setting at baseline. Strengths of the analysis include a multiregional recruitment strategy, incorporation of salient caregiver characteristics, and a 3-year prospective design that allows for the modeling of change in important variables (e.g., care recipient functional status or caregiving indicators) when time to institutionalization is predicted. Design and Methods: Data were derived from the control sample of the Medicare Alzheimer's Disease Demonstration Evaluation (MADDE). A Cox proportional hazards model was used to predict time to institutionalization among individuals with dementia (baseline was enrollment into MADDE). Predictors included care recipient demographics, caregiver demographics, and timevarying measurements of care recipient functional status, caregiving indicators, and service utilization. Indicators of change were also incorporated to capitalize on the prospective data available. Results: Although several results were consistent with prior findings, caregiving indicators (i.e., burden and selfrated health) and community-based service use were significant predictors of earlier placement. Change in caregiver instrumental activities of daily living and care recipient activities of daily living were also related to expedited institutionalization. Implications: The findings emphasize the importance of incorporating both care recipient and caregiver function and service use patterns when targeting programs designed to prevent or delay institutionalization for people with dementia.
The Gerontologist, 1993
An evaluation of medical services for elderly members in the Social Health Maintenance Organizati... more An evaluation of medical services for elderly members in the Social Health Maintenance Organization (SHMO) demonstrations is presented. The SHMOs generally failed to offer special geriatric medical services to the frail elderly, and the coordination of SHMO medical services with the special long-term care and case management services offered by the SHMOs was limited. These limitations led to some problems for the elderly in terms of access, continuity of care, and satisfaction. Variations in medical services occurred across sites, but generally the SHMOs established by mature HMO organizations appeared to offer more efficient and effective medical services than newly formed SHMOs.
Evaluation & the Health Professions, 2004
Preventive case management was implemented by Sharp Healthcare of San Diego with the intention of... more Preventive case management was implemented by Sharp Healthcare of San Diego with the intention of complementing primary care for geriatric patients enrolled in PacifiCare's Secure Horizons Medicare plan. This article presents patient outcomes after 12 months of participation. The program featured an annual screening questionnaire, appointment monitoring, disease education, and self-management support. It used a prospective design, tracking randomly assigned treatment (n= 1,537) and control patient samples (n = 1,542) for 12 months. Outcomes included physical and mental health status; hospital, ER, and nursing home use; hospital days and expenditures among persons having an inpatient stay; and primary care physician visits. Utilization data were obtained from Sharp Healthcare systems and from screening questionnaires. No statistically significant main effects were found, but persons with three or more independent activity of daily living limitations were about half as likely to have a nursing home admission if they were in case management rather than in the control group.
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Papers by Robert Newcomer