Association for Public Policy Analysis & Management

This paper examines the relationship between onsite service availability and health care utilization and expenditures for Medicare FFS beneficiaries aged 65+ residing in HUD-assisted properties. The analysis builds on a previous study that linked 2007-2009 HUD administrative data in 12 jurisdictions with the residents’ Medicare/Medicaid claims data. Approximately two-thirds of residents were found to be dually eligible for Medicare and Medicaid; over half suffered from 5+ chronic conditions and had higher utilization and costs than their non-subsidized peers. A survey was conducted with the properties in the dataset to gather information on  staffing presence (service coordinator, activities coordinator, nurse) and availability of services (activities, transportation, meals, wellness and prevention, health, functional support). Survey data were merged with the linked data set described above and with the Area Health Resource File.  Sixty-nine percent of the properties had a service coordinator in site. Propensity score matching was done to match individuals living in properties with and without service coordinators in the same MSA.  After controlling for resident demographic, disability and health status characteristics, property location and local health care resources, analyses indicated that the availability of an onsite service coordinator reduced the odds of at least one hospitalization by 18%.  Medication management reduced Medicaid payments per enrolled month by 21%.  The service coordinator findings support previous research indicating positive effects of this housing-based position for elderly residents and for health care costs.  Researchers and policymakers need to explore in more detail the potential role of this onsite care coordinator in better managing the health and social needs of this vulnerable elderly population and achieving the triple aims of health care reform.