The Impact of the Vermont Support and Services at Home Program on Healthcare Expenditures

Objective: The Support and Services at Home (SASH) program in Vermont aims to coordinate care and assist participants in accessing the health care and support services they need to maintain their health and age comfortably and safely in their homes. Most program participants are residents of U.S. Department of Housing and Urban Development (HUD)-assisted properties or Low-Income Housing Tax Credit (LIHTC) properties. Our objective is to estimate the impact of the first 5 1/2 years of the SASH program on the Medicare expenditures of these participants. Methods: We use a difference-in-differences model, comparing the change in the expenditures among the SASH participants with the change in the expenditures for a comparison group of Medicare beneficiaries in HUD-assisted or LIHTC properties that did not host the SASH program. Results: Our findings indicate that participants-particularly dual-eligible participants- in SASH panels that are overseen by the Cathedral Square Corporation, and in the subset of those panels that are in an urban county, experience slower growth in total Medicare expenditures and expenditures for hospital care, emergency department visits, and specialist physician visits relative to the comparison group. Conclusions: Although we do not find that the SASH program has a significant impact on Medicare expenditures for all participants in our sample, the favorable results among a subset of panels, containing nearly one-half of the SASH participants in HUD-assisted or LIHTC properties, provides evidence that a housing-plus-services model has the potential to slow the growth of healthcare costs.