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June 2007

PASSPORT Program Found to Be Cost-Effective, Consumer-Responsive

The Scripps Gerontology Center at Miami University last month published the final report of its evaluation of PASSPORT, Ohio's Medicaid home-care program for older Ohioans. Researchers concluded that PASSPORT is "cost-effective, appropriately targeted, quality-oriented, thoroughly monitored and consumer-responsive."

In the last biennial budget (2005-2007), the Ohio General Assembly called for an independent evaluation of PASSPORT. The Ohio Department of Aging (which administers the program pursuant to an agreement with the Ohio Department of Job and Family Services) and an advisory council for the project specified the scope of the evaluation and selected Scripps through a competitive bid process to conduct the review.

Among Scripps' findings:

• People getting services through PASSPORT need them. Most consumers had been identified as unable to perform at least two activities of daily living on their own. The average monthly income of consumers was just $719, and 31 percent had no assets.
• Consumers typically seek only the care they need. Most consumers do not ask for excessive services and balance PASSPORT care with that provided by friends and family.
• Consumer needs are appropriately assessed and managed. PASSPORT case management is highly effective and was widely praised by consumers and caregivers.
• Quality assurances safeguard the health and welfare of consumers. Numerous processes, including annual structural compliance reviews at all levels of administration, incident reporting and satisfaction surveys, focus on the consumer.
• The average PASSPORT provider has been with the program for nine years. Current providers rank the likelihood of continuing with the program at 8.7 out of 10.
• PASSPORT costs are less than half those of similar care in a nursing home. The average yearly Medicaid expenditure for a nursing home resident was $55,751, compared to $23,702 for a PASSPORT client.

Researchers also made several key recommendations to improve the program further:

• Develop a process for gathering and disseminating information about provider quality.
• Evaluate barriers to informed choice, including the consumer's cognitive ability to make an informed decision.
• Review reimbursement rates for providers.
• Strike a balance between statewide standardization for managability and quality (i.e., client record forms and employee timesheets) with the need for local autonomy to form and foster independent relationships between administrating agencies and providers.
• Consider requesting a waiver of the federal requirement that any willing provider that can meet the conditions of participation can become an approved PASSPORT provider.
• Evaluate the Medicaid eligibility determination process to reduce delays in the start of service.
• Develop a streamlined, well-coordinated consumer survey process that yields representative, meaningful and routinely utilized data on consumer outcomes as well as consumer satisfaction.

Read the complete evaluation report.

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