4-Year Evaluation Shows SASH Continues to Slow Medicare Growth

CHPS | December 18, 2017 | by Geralyn Magan

Launched in July 2011, SASH is designed to connect older adults living in or near affordable senior housing sites with community-based health care and support services.

Growth in annual Medicare expenditures was slower for older adults who participated in Support and Services at Home (SASH) panels that launched prior to April 2012 than for non-participants, according to an analysis conducted by RTI International and the LeadingAge LTSS Center @UMass Boston (formerly the LeadingAge Center for Applied Research).

The 4-year evaluation also showed that hospital and specialty physical costs grew at slower rates for early participants in the Vermont-based housing plus services program.

Launched in July 2011, SASH is designed to connect older adults living in or near affordable senior housing sites with community-based health care and support services. At the heart of the SASH model is a team made up a full-time SASH coordinator and a quarter-time wellness nurse work. The team works with formal community partners to coordinate services for a “panel” of up to 100 residents. Each SASH team employs a variety of practices, including comprehensive health and wellness assessments, individualized healthy living goals, one-on-one nurse coaching, care coordination, and evidenced-based and other health and wellness group programs.

During the evaluation period, SASH funding sources included the Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration, managed by the Centers for Medicare and Medicaid Services; Vermont’s Medicaid program; and several state agencies and foundations. Vermont’s All-Payer Accountable Care Organization Model began funding the program after the MAPCP funding ended in Dec. 2016.

Key Finding: Slowing in Growth of Medicare Spending

The RTI/LeadingAge evaluation of Medicare claims data documented better outcomes for participants in early SASH panels, which were established before April 2012. These panels primarily serve residents living in the affordable housing sites where the SASH team is based.

Early participants had lower rates of all-cause hospital admissions and slower growth in annual Medicare expenditures than non-participants. However, there was no evidence that the SASH program reduced participants’ rates of emergency room visits, according to the evaluation.

Medicare claims data also showed that growth in annual Medicare expenditures was slower by an estimated $1,227 per-beneficiary per year among SASH participants in early panels. These same early participants also had slower rates of growth for hospital and specialty physician costs.

There was no evidence that the SASH program decreased Medicare expenditures for participants in the later panels, which tend to be located in rural areas and to include more community participants, according to the report.

Other Findings

Other findings emerged from a survey conducted with SASH participants and non-participants, and interviews with SASH team members and other stakeholders.

  • Functional status: SASH participants reported higher overall functional status, compared to survey respondents who did not participate in SASH. SASH participants and comparison group beneficiaries reported similar overall health status and ability to perform basic daily activities.
  • Self-care: SASH team members said they believed the program helped participants learn self-care and disease self-management skills. SASH participants and wellness nurses reported that they were able to identify health issues before those issues progressed to more serious incidents, according to the report.
  • Medication management: SASH participants reported having significantly less difficulty with common medication management tasks, compared to Medicare beneficiaries who were not in the SASH program.
  • Nutrition: Program staff encouraged SASH participants to eat healthier foods, educated them on nutrition and food labels, and connected them to nutrition-related resources in the community. However, there was no evidence that the SASH program improved participant nutrition, compared to similar Medicare beneficiaries who were not participating in the SASH program.
  • Aging in place: Housing community managers and SASH teams reported that the SASH program has successfully helped participants remain in their homes. The program ensures that participants have the services and resources needed to be safe in their apartments and uphold their tenancy obligations, according to the report.
  • Linkages: Interviews with stakeholders suggested that the SASH program enables better coordination of care by creating linkages between participants and vital resources in the community.

For More Information

To learn more about the SASH evaluation, read a summary of the research or the full evaluation report, both of which were published in November by the Office of the Assistant Secretary for Planning and Evaluation (ASPE) in the U.S. Department of Health and Human Services.