Affordable Senior Housing Plus Services Program Slows Growth in Medicare Costs

Alisha's Blog | December 14, 2014

The Support and Services at Home program is slowing the growth of annual total Medicare expenditures for program participants, according to early findings from a 3-year evaluation conducted by the LeadingAge Center for Applied Research and RTI International.

The Support and Services at Home (SASH) program is slowing the growth of annual total Medicare expenditures for program participants, according to early findings from a 3-year evaluation conducted by the LeadingAge Center for Applied Research and RTI International.

The growth of annual total Medicare expenditures for early SASH participants was $1,756 to $2,197 lower than the growth in Medicare expenditures for beneficiaries in 2 comparison groups.

“These early findings suggest that the housing-based SASH program is bringing added value to Vermont’s health reform effort,” says Alisha Sanders, managing director of the LeadingAge Center for Housing Plus Services.

SASH and Health Reform in Vermont

Based in affordable senior housing, the SASH program helps participants address and coordinate their health and social service needs. SASH teams consist of housing-based care coordinators and wellness nurses that work with dedicated representatives of community-based service agencies to support participating affordable housing residents.

SASH was integrated into Vermont’s Blueprint for Health in 2011. The Blueprint is a statewide health reform effort designed to deliver comprehensive, coordinated care that improves health outcomes and lower costs. 

Under the Blueprint, community health teams support medical homes across the state by providing targeted prevention and disease management assistance to identified patients.

As a partner in the state’s Medicare Multipayer-Advanced Primary Care Practice (MAPCP) demonstration, SASH supports the community health teams by providing focused in-home support and services to Medicare beneficiaries in affordable senior housing properties and their surrounding communities. The MAPCP demonstration pays for the SASH onsite care coordinator and wellness nurse team.

First-Year Findings

The SASH evaluation is funded by the Office of the Assistant Secretary for Planning and Evaluation at the U.S. Department of Health and Human Services. 

The first-year evaluation compared SASH participants living in U.S. Department of Housing and Urban Development (HUD)-assisted properties to 2 demographically similar groups:

  • Medicare beneficiaries in Vermont who live in HUD-assisted properties and are included in a MAPCP medical home, but are not SASH participants (non-SASH/MAPCP). 
  • Medicare beneficiaries in upstate New York living in HUD-assisted properties who are not participating in a MAPCP demonstration program or the SASH program (non-SASH/non-MAPCP).

First-year results show that, between the baseline and intervention periods, total Medicare expenditures increased for all groups. However, the growth in these expenditures was lower for SASH participants, relative to either comparison group.

The evaluation also examined SASH participants who joined the program earlier and those who joined later.

The purpose was to gauge the impact of SASH on participants who had a longer exposure to more mature program operations. Those who joined the program earlier experienced a statistically significant lower rate of growth in:

  • Total Medicare expenditures and post-acute care payments, compared to the non-SASH/MAPCP group.
  • Total Medicare expenditures and acute care, post-acute care and hospital outpatient payments, compared to the non-SASH/non-MAPCP group.

This may indicate that the SASH program will see a continued, and, perhaps, stronger effect as it operates longer.

How SASH Works

Cathedral Square Corporation, an affordable housing provider in South Burlington, VT, developed SASH in collaboration with a network of housing and community-based service providers. 

Currently, SASH operates in 118 affordable housing sites, including public housing and various non-profit-owned housing. Individuals from the surrounding community may also participate in the program.

A housing property’s SASH team conducts a comprehensive assessment of participating residents and works with participant to develop and implement a plan that addresses their health and wellness needs. 

The SASH coordinator and wellness nurse support participants in a variety of ways, including:

  • Assisting with transition support after a hospital or rehabilitation facility stay.
  • Providing self-care management education and coaching.
  • Offering care coordination services.

The team also uses assessment data to identify appropriate, evidence-based health and wellness programs that it conducts in each housing community to address the specific needs of the resident population.