ASPE Contract: Evaluation of Supports and Services at Home (SASH) Program

Center Post

The LeadingAge Center for Applied Research is working with RTI International on a newly awarded contract to evaluate the Supports and Services at Home (SASH) program. The U.S. Department of Health and Human Services (HHS) is funding the evaluation.

The SASH program uses not-for-profit housing as a platform for coordinating and delivering health and supportive services to seniors and people with disabilities. SASH participants live in the housing properties and their surrounding communities. The interdisciplinary SASH team includes a SASH coordinator and wellness nurse who are based at the housing property, and representatives from a network of community-based service providers.

Cathedral Square Corporation in South Burlington, VT, developed the SASH program, which is currently being rolled out to 112 housing sites through Vermont’s Multi-payer Advanced Primary Care Practice (MAPCP) demonstration.

The demonstration, funded by the Centers for Medicare and Medicaid Services, is designed to support state efforts to improve the quality and coordination of health care services through team-based “medical homes.”

SASH Evaluation Activities 

During the 3-year evaluation, the Center for Applied Research and RTI International will examine the development and implementation of the SASH program as well as outcomes for program participants. Primary study activities will include:

  • An annual statistical comparison: Researchers will compare SASH participants, SASH non-participants and a Medicare beneficiary comparison group. The comparison will look at acute care utilization, Medicare expenditures, transfers to nursing homes and adverse medical events. Cost-effectiveness and cost-benefit analyses at the end of the third year will quantify the net savings to Medicare and Medicaid.
  • Survey of beneficiary groups: A survey of SASH participants, SASH non-participants and a Medicare beneficiary comparison group will help researchers assess outcomes that are not available from Medicare and Medicaid claims data. These outcomes will focus on issues related to general health status, functional status, quality of life, polypharmacy and diet. The survey will also examine reasons for non-participation among older adults who are eligible for the SASH program. 
  • Calls and site visits: Researchers will communicate with SASH program staff through quarterly calls. They will also conduct interviews with program staff, community partners and other stakeholders during annual sites visits. These interviews will examine key features of the SASH initiative and how they evolve over time; implementation barriers and facilitators; perceived pros and cons for program participants; and lessons learned.

Implications for Providers

At the end of the MAPCP demonstration, the HHS Secretary has the option of making demonstration activities a permanent component of the Medicare program. The evaluation findings could help inform this decision.

Evaluation results could also inform policy efforts at the federal and state level related to the role that affordable housing linked with health and supportive services could play in addressing health and long-term care reform goals.

For more information about the SASH evaluation, contact Alisha Sanders at 202-508-1211.