It’s time to completely overhaul the current system for delivering health care and long-term services and supports (LTSS) to seniors nationwide, according to LeadingAge.
The industry association, which represents more than 6,000 not-for-profit senior care providers, believes that its members in particular are “well positioned to play a central role in [its proposed] new system,” which will be “far more efficient, and will take a far more comprehensive view of each older adult’s need for medical care, housing, social supports and financial security,” according to a recently published report.
The stars are aligning for such a drastic overhaul to take place, according to Nicole Fallon, the report’s author and LeadingAge’s vice president of health policy and integrated services.
“Congress is at a point where it really wants to talk about reform, and policymakers talk about the unsustainability of Medicare and Medicaid,” Fallon told Senior Housing News. “It feels like the environment right now is ripe for a conversation about reform.”
A holistic approach
Specifically, LeadingAge is calling for an integrated service delivery model that is person-centered, addresses seniors’ needs in a holistic way, achieves better health outcomes, more efficiently utilizes available public and private resources, and helps Americans of all ages live better lives.
“One of the things that makes our report unique is that we’re saying that integrating services isn’t just good for people who are dually eligible [for Medicare and Medicaid],” Fallon explained. “It’s good for anyone who has a chronic condition, is aging, or has multiple access points to service providers.”
The primary aim of this wider population focus is to reduce the number of seniors who develop high needs and high costs, while also diminishing the growth of Medicaid and additional public financing, the report says.
The integrated service model proposed by LeadingAge would be implemented by an organized, community-based “hub” of providers working together to deliver supports and services to individuals. Importantly, and unlike Medicare accountable care organizations (ACOs), the hub could be directed by a community-based LTSS organization, just as it could a hospital, health plan, doctor or health system, Fallon noted.
“We would argue that because LTSS providers often see older adults on a daily or multiple-times-a-day basis, we are closer to those individuals,” Fallon said. “When we think about integration, we don’t want it to start with just an emergent situation [like a hospital visit].”
At the same time, LeadingAge envisions a new universal LTSS insurance system to provide financial support for the aforementioned integrated service model.
A successful model
A great example of LeadingAge’s proposed integrated services model is the Cincinnati-based Post-Acute Care Network (PACN), according to the report.
PACN was initially established when two life plan communities in Cincinnati—Life Enriching Communities and Episcopal Retirement Services—partnered with Home Care by Blackstone. Now, the group includes 11 organizations that work together, even though they’re competitors in the same marketplace, the report says.
“You need to have kind of that broad array of providers that are part of your network or that you can partner with,” Fallon explained.
The PACN model encompasses many of the critical elements of LeadingAge’s proposed integrated service model, in that it follows seniors across settings, brings together senior supports and services, acts as a bridge as seniors transition between sites of service, and optimizes services and care, according to LeadingAge.
Additionally, PACN managed to reduce skilled nursing length of stay by 9% from 2014 to 2016.
All of this isn’t to say that the PACN integrated services model will work everywhere.
“We don’t think there’s one way to approach this,” Fallon said. “Every health care marketplace will address this differently.”
Written by Mary Kate Nelson