The 'GRACE' Model: In-Home Assessments Lead To Better Care For Dual Eligibles

SYSTEMS Wishard Health Services, based in Indianapolis, Indiana, the third-largest safety-net health organization in the United States; HealthCare Partners Medical Group (Los Angeles); the Indianapolis Veterans Affairs (VA) Medical Center (part of the Veterans Health Administration Office of Geriatrics and Extended Care); and the Aging and Disability Resource Center Evidence-Based Care Transition Programs, funded by the US Administration on Aging and the Centers for Medicare and Medicaid Services. KEY INNOVATION Geriatric Resources for Assessment and Care of Elders (GRACE), an integrated care model targeting low-income seniors, many dually eligible and most with multiple chronic conditions. The model uses in-home assessments by a team consisting of a nurse practitioner and a social worker to develop an individualized plan of care. COST SAVINGS In a randomized controlled trial of 951 adults age sixty-five and older, with incomes below 200 percent of the federal poverty level, high-risk patients enrolled in GRACE had fewer visits to emergency departments, hospitalizations, and readmissions and reduced hospital costs compared to the control group. The two-year GRACE intervention saved $1,500 per enrolled high-risk patient by the second year. QUALITY IMPROVEMENT RESULTS In the same randomized controlled trial, GRACE received high ratings by physicians. GRACE patients also reported higher quality of life compared with the control group. CHALLENGES The GRACE model improves health and reduces costs in a capitated system, but only 10 percent of its costs are covered by fee-for-service Medicare.