Managing the Long-Term Care of Dual Eligibles

When it comes managing the long-term care of dual eligibles, many health systems are looking toward managed long-term supports and services (MLTSS). Unlike traditional Medicare and Medicaid, MLTSS would expand managed healthcare medical services to include personal support and other assistance. It also would replace the fee-for-service reimbursement model with a capitated, risk-based model in which a managed care organization (MCO) and its strategic care partners would control costs and improve outcomes by coordinating a patient’s care. The goal of this collaborative effort would be to provide services that will reduce a patient’s risk of hospitalization. This would include everything from providing them with an aide to giving them a taxi ride or a wireless scale.

“Done well, this model has the potential to improve the quality of life for those receiving care, and save money,” said Howard Gleckman, resident fellow at The Urban Institute. However, he warns that, “Done poorly, it puts an extremely vulnerable population at even greater risk than it is today—and may not save money.”

The Catholic Health Association (CHA) recently published a report that detailed the opportunities and challenges it faces as it tries to manage the long‐term care of elderly patients. They suggest that MLTSS is a promising alternative to traditional models of Medicare and Medicaid, which are inefficient and costly.

“Because MLTSS is so new, there are limited data to support its efficacy,” the group said in the report. “However, there appear to be significant opportunities to address inefficiencies in the existing model.”

CHA said that traditional Medicare and Medicaid models incentivize volume rather than value. This can drive patients to the highest-cost providers, including hospitals or physicians, instead of to skilled nursing facilities or physician assistants—even though there is no difference in the quality of service provided by the lower-cost options. As well, CHA suggested that dual eligibles receive care through “2 largely disconnected payment streams.” Medicaid pays for supports and services, but not medical care. Medicare pays for medical costs, but not long-term supports and services.

“Make no mistake, this isn’t simple. Patients often have multiple, complicated chronic conditions. Getting docs, hospitals, and long-term care providers to pull together is hard even when their financial incentives are aligned. But the model at least has the potential to improve care for those with chronic illness or injury,” said Mr Gleckman. “If it works, don’t be surprised to see it expanded to include Medicare managed care or Medicare Advantage members.”

Around the Web

Better Coordinating Long-Term Care and Medical Treatment [Forbes]

Facing the Final Frontier [CHA]