Association for Public Policy Analysis & Management

The Support and Services at Home (SASH) program in Vermont aims to coordinate care and assist participants, the majority of whom are Medicare beneficiaries, in accessing the health care and support services they need to stay healthy and age comfortably and safely at home. Each SASH panel of 100 participants is staffed by a services coordinator and a part-time wellness nurse, who provide services, programming, and health care monitoring in participants' homes. Our objective is to estimate the impact of the first three years of the SASH program on the Medicare expenditures and health care utilization of participants living in affordable congregate housing.

The intervention group for this study consists of a sample of 1,600 Medicare FFS beneficiaries who participated in SASH panels between July 1, 2011 and June 30, 2014. Both intervention and comparison groups are residents of properties that receiving funding assistance through the U.S. Department of Housing and Urban Development, or tax credits through the Low Income Housing Tax Credit. We use a difference-in-differences model, comparing the change in the quarterly outcomes among the SASH participants with the change in the quarterly outcomes for the comparison group. Our model controls for beneficiary-level demographic and health characteristics, and it includes fixed effects for the time quarters and for each of the congregate housing properties. We reported the effects of the SASH program on Medicare expenditures and health care utilization, both for SASH program participants as a whole and for two subgroups of participants identified by their panel start date.

Our findings indicate that participants in SASH panels that began operation in the first three quarters of the program experience a reduction in the rate of growth in total Medicare expenditures and expenditures for emergency room, hospital outpatient departments, and primary care/specialist physicians relative to the comparison group. These lower rates of expenditure growth are particularly strong in the third year of the program. This decreased growth in Medicare expenditures over the three years for the early SASH panels is consistent with the hypothesis that the start-up activities for a SASH panel reduce that panel’s ability to make a significant impact on Medicare expenditures and utilization in the first few quarters of operation. Future years of research will help us to determine if the later cohort of SASH panels are as successful in reining in Medicare cost growth as the early panels have been, and if the expenditure reductions experienced by the early panels in the first three years are sustained over a longer period of time.

Our principal findings suggest that SASH is a promising intervention for reducing the growth of Medicare expenditures among a population of elderly and disabled residents living in affordable congregate housing. If future research confirms our hypothesis that Medicare cost growth can be reduced as a panel matures, then this model of providing in-home services for elderly residents of affordable congregate housing properties may have viability beyond Vermont.