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Addressing the “Total Taxpayer” Problem to Translate Veterans Health Administration Innovations in Long-Term Supports
Robert E. Burke, Bruce P. Kinosian. Public Policy & Aging Report, 2019-10-28
Topic: Risk, prevention and care in population studies
This includes adapting and disseminating care delivery innovations from one system to another, as well as measuring and sharing in the improved outcomes and reduced costs that might result. The Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act in 2018 has opened the possibility for Medicare Advantage plans to also pay for HCBS, with the intent of promoting aging in place and addressing social determinants of health (Thomas et al., 2019). The Centers for Medicare and Medicaid Innovation (CMMI)-funded Independence at Home (IAH) demonstration was adapted from the VHA’s Home-Based Primary Care (HBPC) program and, across the first two years of its rollout, demonstrated per beneficiary cost savings ten times as great as those of Pioneer Accountable Care Organizations ( Independence at Home Learning Collaborative Writing Group, Kinosian, Taler, Boling, Gilden, &2016; Independence at Home Learning Collaborative Writing Group, Rotenberg, Kinosian, Boling, Taler, & 2018). A recent systematic review of interventions to prevent or delay long-term institutionalization among community-dwelling adults with physical and/or cognitive impairments concluded that no single model consistently reduced long-term institutionalization, pointing to the need to continue to develop, evaluate, and disseminate new models (Duan-Porter et al., 2019). The Independence at Home initiative doesn’t just save money for Medicare, it also extends the average community residence by 12.8 months when integrated with HCBS, as compared to Medicare patients who would qualify for Independence at Home alone in the National Health and Aging Trends Survey. Simple questions, such as how large these populations are, how frequently they are receiving services from multiple payors, and how often these services are duplicative versus complementary, are lacking and could be facilitated by advisory bodies to the respective programs (the VHA Geriatrics and Extended Care Data Analysis Center, the Medicaid and Medicare Policy Analysis Centers). Our early experience suggests that developing standard data-sharing mechanisms between states and the VHA system, as well as mechanisms for sharing medical and HCBS data about individual veterans between the VHA and Medicaid providers, are significant initial barriers that must be addressed to align supports.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
APA 7th
Burke, R. E., & Kinosian, B. P. (2019). Addressing the “Total Taxpayer” Problem to Translate Veterans Health Administration Innovations in Long-Term Supports. Public Policy & Aging Report. https://doi.org/10.1093/ppar/prz029
Vancouver
Burke RE, Kinosian BP. Addressing the “Total Taxpayer” Problem to Translate Veterans Health Administration Innovations in Long-Term Supports. Public Policy & Aging Report. 2019. doi:10.1093/ppar/prz029.
BibTeX
@article{burke2019-67bab331,
author = {Burke, Robert E. and Kinosian, Bruce P.},
title = {{Addressing the “Total Taxpayer” Problem to Translate Veterans Health Administration Innovations in Long-Term Supports}},
journal = {Public Policy \& Aging Report},
year = {2019},
doi = {10.1093/ppar/prz029},
url = {https://doi.org/10.1093/ppar/prz029}
}
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
Key findings
- This includes adapting and disseminating care delivery innovations from one system to another, as well as measuring and sharing in the improved outcomes and reduced costs that might result.
- The Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act in 2018 has opened the possibility for Medicare Advantage plans to also pay for HCBS, with the intent of promoting aging in place and addressing social determinants of health (Thomas et al., 2019).
- The Centers for Medicare and Medicaid Innovation (CMMI)-funded Independence at Home (IAH) demonstration was adapted from the VHA’s Home-Based Primary Care (HBPC) program and, across the first two years of its rollout, demonstrated per beneficiary cost savings ten times as great as those of Pioneer Accountable Care Organizations ( Independence at Home Learning Collaborative Writing Group, Kinosian, Taler, Boling, Gilden, &2016; Independence at Home Learning Collaborative Writing Group, Rotenberg, Kinosian, Boling, Taler, & 2018).
- A recent systematic review of interventions to prevent or delay long-term institutionalization among community-dwelling adults with physical and/or cognitive impairments concluded that no single model consistently reduced long-term institutionalization, pointing to the need to continue to develop, evaluate, and disseminate new models (Duan-Porter et al., 2019).
- The Independence at Home initiative doesn’t just save money for Medicare, it also extends the average community residence by 12.8 months when integrated with HCBS, as compared to Medicare patients who would qualify for Independence at Home alone in the National Health and Aging Trends Survey.
Why it matters
This review discusses adapting long-term care innovations, such as home-based primary care, between health systems and notes that no single model consistently reduced long-term institutionalization. It does not address treating, curing, or preventing Alzheimer's disease.
Study details
- Study designsystematic review
- Evidence strengthHigh
How this study scored 16/100
Report — not peer-reviewed. It scored 34 on the same rubric, but non-peer-reviewed sources are capped at 16, so it shows as 16. Scored zero for sample size, effect reported and studied in people because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 2 / 10 | Tier 4 — not a peer-reviewed journal (Public Policy & Aging Report) |
| Journal's citation record | 0 / 4 | Not a journal article, so the journal's record does not count |
| Study design | 12 / 12 | A systematic review of all the studies on the question |
| Strength of evidence | 5 / 5 | Rated “high” in our summary |
| Peer-review validation | 3 / 10 | Report — not peer-reviewed. Named source is an organisational report, not a journal article. |
| How recent | 2 / 5 | 2019 — within 10 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | A review of other studies — randomisation is not credited here |
| Times cited | 1 / 7 | Cited 2 times (OpenAlex, 2026-10-10) |
| Citations per year | 0 / 5 | 0.2 citations a year over 9 year(s) since 2019 |
| Impact for its field and year | 1 / 6 | Cited 0.3× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 0 / 4 | Cited 1 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author Bruce P. Kinosian: h-index 41 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | University of Pennsylvania: institution h-index 1,859 (OpenAlex) |
| Multi-centre collaboration | 1 / 3 | OpenAlex lists 3 institution(s) in 1 country |
| Indexed in PubMed | 1 / 2 | Not in PubMed, but has a DOI |
| Free to read | 2 / 2 | Free to read |
| Total | 34 / 100 | Capped to 16 because this is not a peer-reviewed article. |
What each of these 20 components measures, and what this score is not →
Read the original
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
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