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National Journal Highlights Study Showing that SASH Reduces Emergency Room and Specialist Visits

An August 2018 article published in the national research journal Cityscape reports that Vermont’s SASH (Support and Services at Home) program for older adults and people with disabilities is slowing the growth of Medicare expenditures in emergency-room visits and specialist services.

Most SASH participants live in congregate affordable housing. They are supported by a statewide network of social-service agencies and health-care partners, including nonprofit housing organizations, area agencies on aging, community mental health centers, home health agencies, primary and community care teams, and regional hospitals. Participants receive individualized support at home from a SASH care coordinator and a wellness nurse, who together with these partners help 5,000 SASH participants remain independent and living at home.

The authors undertook a deeper analysis of data collected over the past 5 ½ years as detailed in the latest federal evaluation of SASH, a program of care coordination and support based in congregate affordable housing and carried out by a statewide network of partners in health, affordable housing and human services. They examined data for all 54 Vermont “panels” (groups of approximately 100 SASH participants each) and determined:  

  • Medicare expenditures for emergency-room visits trended lower for almost all SASH panels in the state compared to the control group, with the urban panels (those in Chittenden County) and longest-running panels (those in place when SASH began in 2011) showing statistically significant reductions in spending for emergency-room visits. 

  • Similarly, expenditures for specialist visits also trended lower — and primary-care visits trended higher — for all panels, again with the statistically significant results among urban and early panels. 

  • Additionally, this analysis shows statistically significant results for slowing the growth of Medicare expenditures for SASH participants who are dually eligible for both Medicare and Medicaid in the early and urban panels.  

These results correspond with Vermont’s focused efforts to encourage Vermonters to rely on primary care rather than specialists or emergency departments for their health needs and otherwise rein in the cost of health care. 

“We’ve known that SASH is saving Medicare costs for many of our participants, but to know that we’re having a significant impact on emergency room and specialist costs for a subset of our SASH panels is very exciting,” said SASH Director Molly Dugan.  “It’s also important to note that the statistically significant findings are very much tied to sample size, because the urban panels account for almost half of the SASH participants in the sample used for the data evaluation,” she added. “With a larger sample size, it’s very possible that all SASH panels would have significant findings.”


About SASH 

Developed by South Burlington-based Cathedral Square and operating statewide since 2011, SASH is a partnership that helps Medicare recipients living in or near subsidized housing communities in Vermont access health care and support services to help them remain living independently at home. The program is managed regionally by six nonprofit housing organizations (Brattleboro Housing Partnerships, Cathedral Square, Downstreet Housing & Community Development, Rural Edge, Rutland Housing Authority, and Shires Housing.) SASH is free for participants, with funding provided by Medicare through the All-Payer ACO Model and the state of Vermont.

About the Article

“The Impact of the Vermont Support and Services at Home Program on Healthcare Expenditures” was written by researchers from RTI International, the University of North Carolina at Greensboro and the LeadingAge LTSS Center at UMass Boston. Cityscape is published three times a year by the Office of Policy Development and Research of the U.S. Department of Housing and Urban Development, with the goal of bringing “high-quality original research on housing and community development issues to scholars, government officials, and practitioners.” The complete document is available online at: https://www.huduser.gov/portal/periodicals/cityscpe/vol20num2/article1.html.