Cost Analysis of a Home-Based Nurse Care Coordination Program

Objectives To determine whether a home‐based care coordination program focused on medication self‐management would affect the cost of care to the Medicare program and whether the addition of technology, a medication‐dispensing machine, would further reduce cost. Design Randomized, controlled, three‐arm longitudinal study. Setting Participant homes in a large Midwestern urban area. Participants Older adults identified as having difficulty managing their medications at discharge from Medicare Home Health Care (N = 414). Intervention A team consisting of advanced practice nurses (APNs) and registered nurses (RNs) coordinated care for two groups: home‐based nurse care coordination (NCC) plus a pill organizer group and NCC plus a medication‐dispensing machine group. Measurements To measure cost, participant claims data from 2005 to 2011 were retrieved from Medicare Part A and B Standard Analytical Files. Results Ordinary least squares regression with covariate adjustment was used to estimate monthly dollar savings. Total Medicare costs were $447 per month lower in the NCC plus pill organizer group (P = .11) than in a control group that received usual care. For participants in the study at least 3 months, total Medicare costs were $491 lower per month in the NCC plus pill organizer group (P = .06) than in the control group. The cost of the NCC plus pill organizer intervention was $151 per month, yielding a net savings of $296 per month or $3,552 per year. The cost of the NCC plus medication‐dispensing machine intervention was $251 per month, and total Medicare costs were $409 higher per month than in the NCC plus pill organizer group. Conclusion Nurse care coordination plus a pill organizer is a cost‐effective intervention for frail elderly Medicare beneficiaries. The addition of the medication machine did not enhance the cost effectiveness of the intervention.