Washington, D.C.– Addressing the quality and cost of caring for people with complex care needs is a major challenge facing America’s health care system. Today the Bipartisan Policy Center releases a new report, A Policy Roadmap for Individuals with Complex Care Needs, which identifies policy solutions on ways to finance and deliver quality care to this vulnerable population.
In 2010, 37 percent of Medicare beneficiaries had four or more chronic conditions, and accounted for 90 percent of Medicare hospital readmissions and 74 percent of Medicare program spending. Challenges for high-need adults can be even greater for those who are low-income or disabled and eligible for both Medicare and Medicaid.
Research shows that for some people with complex care needs, providing social services not traditionally covered by Medicare can reduce unnecessary hospitalizations and reduce emergency visits. These services can include: targeted care management, personal care services or other home or community-based assistive services, in-home meal delivery, home modifications, and transportation to doctor’s appointments. However, care models based on fee-for-service make it difficult to provide this type of coordinated care.
Ensuring better integration of non-Medicare covered health-related supports and services into risk-based care models must be a top priority as we create new care delivery approaches.
“Ensuring better integration of non-Medicare covered health-related supports and services into risk-based care models must be a top priority as we create new care delivery approaches,” said Katherine Hayes, BPC’s health policy director. “Providing these services to frail elderly adults or those with behavioral and social needs can improve care for patients and their caregivers, improve health outcomes, and in some cases, lower costs.”
BPC’s Recommendations Focus on Five Policy Areas:
1) Providing flexibility in Medicare Advantage to better integrate health and social services and supports for Medicare patients with the greatest needs and highest costs.
2) Aligning programs serving dual-eligible Medicare and Medicaid beneficiaries to better coordinate care.
3) Expanding Medicaid options at home and in the community.
4) Increasing the availability and affordability of private long-term care insurance to extend existing resources.
5) Supporting family caregivers and making long-term services and supports available through Medicare Advantage and Medigap.
The report emphasizes that the pathway to improving the quality of care and value of services provided to those with complex care needs must include person- and family-centered care; coordinated care that is not redundant in services and costs, strategies that eliminate barriers to coordinated care; family and caregiver support; and financing strategies that assist with the delivery of long-term services and supports.
Hayes added, “There is no single solution to solving the challenges of delivering clinical services and long-term services and supports to those who have medical and functional needs. While not a comprehensive solution, the recommendations outlined in this report could help create a more patient-centered system for this vulnerable population and greatly improve both the quality and value of care they receive.”
KEYWORDS: LONG-TERM SERVICES AND SUPPORTS