March 8 - Bethesda, MD - Major changes lie ahead in the structure and delivery of long-term health care services and supports, accelerated by the Affordable Care Act. Among these are expanded options for people to receive services in their homes and communities; care coordination for the disabled population dually enrolled in Medicare and Medicaid; and the creation of a new social insurance program dedicated to providing help for people with disabilities.
To meet the needs of policy makers for increased tracking and analysis of these and other issues, Health Affairs, the nation's leading health policy journal, with the support of The SCAN Foundation, is launching a new feature called The Care Span. The series will debut with two articles in the March issue of Health Affairs:
A high-performing system of long-term services and supports.
Susan C. Reinhard, of the Public Policy Institute at AARP, and colleagues explore how the Affordable Care Act of 2010 can help move states toward creating a better system of long-term services and supports, with options beyond nursing homes and institutional care. The authors note that enhanced federal funding will incentivize states to establish a care system that meets the diverse needs and preferences of people with disabilities. To help states assess their systems, AARP, the Commonwealth Fund, and The SCAN Foundation are sponsoring a "scorecard" project to articulate what a high-performing system of long-term services and supports should look like. Once this tool is available, it will permit comparisons among states and make it possible to measure progress in individual states over time.
Reinhard and her colleagues also outline five key characteristics of a high-performing system of long-term services and supports. Such a system, they argue, should recognize and support the family and other unpaid caregivers, so that they can maintain their own well-being and continue providing care; provide ease of access and affordability to people in need of long-term services and support; take a "person-centered" approach that allows people to receive supports where and from whom they choose; ensure that long-term services and supports are safe and effective and enhance the quality of life of the people receiving them; and integrate long-term services and supports with health-related services, such as clinical care and physical therapy, as well as with social supports, such as transportation, to ensure smooth and effective care transitions when they are necessary.
Palliative care can cut hospital costs for Medicaid programs.
R. Sean Morrison, of the Mount Sinai School of Medicine in New York City, and colleagues, examined the effects on hospital costs of palliative care team consultations for patients enrolled in Medicaid at four New York State hospitals. Palliative care is "team-based" care that focuses on improving quality of life for persons living with serious or life-threatening illness and their families. Palliative care, provided alongside disease directed treatments, has been shown to reduce pain and other symptoms, alleviate family distress, and improve survival.
On average, patients who received palliative care incurred $6,900 less in hospital costs during a given admission than a matched group of patients who received usual care. The researchers estimate eventual reductions in Medicaid hospital spending for New York State of up to $252 million, if every hospital with 150 or more beds had a fully operational palliative care team.
In addition, palliative care recipients spent less time in intensive care, were less likely to die in intensive care units, and were more likely to receive hospice referrals than their counterparts who did not receive palliative care. The authors identify a number of implications for policy makers, including the need for workforce incentives to assure availability of trained and skilled palliative care providers, recognition of palliative care in pay-for-performance schemes, and inclusion of palliative care services in new delivery and payment models, such as accountable care organizations.
About The Care Span
The Care Span will cover a range of topics relevant to long-term services and supports, as well as aging, disability, chronic disease, end-of-life care, community-based care, and the continuum of care.
"We believe that this new, ongoing feature in Health Affairs will spur important discussions in long-term services and supports, and inform the adoption and implementation of key policies and reforms," said Susan Dentzer, editor-in-chief of Health Affairs. "As our nation grapples with an aging population and increasing rates of chronic illness, access to robust research and high-level analysis will be crucial to finding solutions. Through our partnership with The SCAN Foundation we will be able to bring this information to policy makers."
"Medical and population health advances have added years to our life expectancy, resulting in a rapidly aging demographic in this country that will have significant long-term care needs in the coming years," stated Dr. Bruce Chernof, president and chief executive officer of The SCAN Foundation. "Public policy has not kept up with these changes, and we are delighted to partner with Health Affairs as they launch The Care Span series to shine a light on these critical issues for seniors of today and tomorrow."
A full table of contents from the March issue is available here: http://www.healthaffairs.org/Media/2011_Mar_TOC.pdf
Abstracts for all studies in the March issue of Health Affairs can be accessed from March 8, 2011 at www.healthaffairs.org