The effect of the right care, right place, right time (R3) initiative on Medicare health service use among older affordable housing residents

Abstract

Objective To determine the effect of an affordable housing‐based supportive services intervention, which partnered with health and community service providers, on Medicare health service use among residents. Data Sources Analyses used aggregated fee‐for‐service Medicare claims data from 2017 to 2020 for beneficiaries living in 34 buildings in eastern Massachusetts. Study Design Using a quasi‐experimental design, a “difference‐in‐differences” framework was employed to isolate changes in outcomes, focusing on changes in pre‐ and post‐intervention health service use across two stages of the intervention. Phase 1 encompassed the initial implementation period, and Phase 2 introduced a strategy to target residents at high risk of poor health outcomes. Key health service outcomes included hospitalizations, 30‐day hospital readmission, and emergency department use. Data Collection Medicare claims data for 10,412 individuals were obtained from a Quality Improvement Organization and aggregated at the building level. Principal Findings Analyses for Phase 1 found that hospital admission rates, emergency department admissions and payments, and hospital readmission rates grew more slowly for intervention sites than comparison sites. These findings were strengthened after the introduction of risk‐targeting in Phase 2. Compared to selected control buildings, residents in intervention buildings experienced significantly lower rates of increases in inpatient hospitalization rates (−16% vs. +6%), hospital admission days (−25% vs. +29%), average hospital days (−12% vs. +14%), hospital admission payments (−22% vs. +33%), and 30‐day hospital readmission rates (−22% vs. +54%). When accounting for the older age of the intervention residents, the size of the decline recorded in emergency department admissions was 6.7% greater for the intervention sites than the decline in comparison sites. Conclusions A wellness‐focused supportive services intervention was effective in reducing select health service use. The introduction of risk‐targeting further strengthened this effect. Age‐friendly health systems would benefit from enhanced partnerships with affordable housing sites to improve care and reduce service use for older residents.

Utilizing the 4Ms framework to create a structure and process to support voluntary health assessments in affordable housing

“…It provides an option for co‐location of services in the affordable housing buildings and facilitating direct linkages to existing community‐based services and supports. This approach offers a different perspective on aging in place that adds to previous work that focuses on enhancing wellness, health promotion/disease prevention activities, and healthcare cost savings 6,7,10–16 by adding a replicable 4Ms‐RHRA that incorporates interprofessional education, experiential training, and team‐based care. It provides a foundational element upon which to base a core interprofessional curriculum with a real‐time immersive community‐based experience in affordable housing for undergraduate and graduate level health professions students, precepting faculty, and affordable housing staff.…”

“…The structure and process guides practice, recommendations for intervention, and monitoring within the 4Ms framework. This approach addresses challenges related to monitoring outcomes and impact encountered in other interventional studies 6,7,[10][11][12][13][14][15][16] and is flexible enough to be replicated in other affordable housing settings with different staffing configurations and changes in workflow.…”

Promoting Sustainability in Housing with Services: Insights From the Right Care, Right Place, Right Time Program

“…Using data from 31 individual key informant interviews and three focus groups with payers, housing providers, and community partners, we report and analyze expert perspectives on feasible strategies for how such programs can achieve financial sustainability. This effort was part of the evaluator’s overall charge (set by funders and the project’s advisory group) to not only assess the program’s quantitative outcomes (published as Nadash et al, 2021; Simpson et al, 2023), but also to address ways to ensure financial sustainability, given that sustainability has been identified as one of the biggest barriers to the expansion of supportive housing models (Butler & Cabello, 2018).…”

Unaffordable housing and cancer: novel insights into a complex question

“…Rigorous quasi-experimental methods can also be used to evaluate the health-related effects of housing policies. For example, a recent study used a difference-in-difference design to identify an effect of an affordable housing–based supportive services intervention (the Right care, Right place, Right time program) on reduced utilization rates of Medicare health services use (eg, inpatient hospitalizations and emergency department visits) among Massachusetts residents exposed to the program compared with similar residents who were not exposed ( 22 ).…”