Integrating Long Term Care into the Health Care System

Integrated health care is defined as healthcare services combining the best of conventional and complementary health care. Due to the aging population the idea of integrated health care has become a popular issue. With integrated health care already established in 8 states across the nation – New York, Minnesota, Arizona, Florida, Massachusetts, Wisconsin, Hawaii, and New Mexico – making integrated health care nationwide would be a smart idea. By the year 2020 over 12 million Americans will need long term care. These individuals account for 70% of Medicaid expenditures, but only a quarter of all of Medicaid enrollees. Integrated health care systems are trying to improve quality, coordination, and cost-effectiveness of care. An integrated health system will integrate the financing, delivery, and administration of primary, acute, long-term care, chronic and behavioral health services for adults who are dually eligible for Medicaid and Medicare, as well as those who receive services solely through Medicaid.

Today of the 7 million Americans deemed as “dual eligibles,” meaning they are covered by both Medicaid and Medicare. Integration of health care is difficult because Medicaid and Medicare are governed by their own delivery, financing, and administrative policies which misalign benefit structures. Medicare covers only medically necessary skilled nursing facility or home health care. Medicare does not cover what they call “custodial care,” which is considered activities of daily living like dressing, bathing, feeding, etc. An integrated health system will help to combine all these needs into one program that an individual who would need this type of care can have it.

In 1998 almost 20% of all Medicare beneficiaries received care in more than one setting, in turn resulting in less of a need to coordinate and integrate care for patients moving from one setting to the next. Provider competition has prevented the integration process which would provide a smoother transition from one health care setting to the next. The Balanced Budget Act of 1997 cut Medicare’s budget and forced providers to focus on financial survival, rather than trying out new ways of care. From that came Medicare’s prospective payment systems (PPS). PPS’s created separate reimbursements for where the care is provided. These incentives made providers focus only on their own site and financial survival.

In Wisconsin the integrated health care program involves all people with the decisions of receiving what kind of care. A team is usually compromised of an enrollee, enrollee’s primary care physician, a nurse practitioner, a registered nurse, and a social worker or social service coordinator. This approach has been central to eliminating system and service fragmentation, increasing comprehensive primary care, and providing support for the person in his or her home. It has also helped minimize the need for expensive hospital and nursing home care. The team conducts assessments, develops plans of care including the provision of health and psychosocial services to meet identified needs, and arranges for the delivery of the services whether they are staff-provided or purchased from subcontractors. Examples of services include primary health care, hospital care, transportation, supportive home care, personal care, and home modifications. Payments are a mix of institutional and home and community-based care costs. Rates are risk-adjusted by age, level of care, and Medicare eligibility, dual eligible or only Medicaid eligible.

Integrated care overall will improve cost savings and reduce inappropriate care and increase the quality of outcomes. For consumers, integration is assumed to produce more convenient, accessible, and clinically effective systems by reducing the degree of service and system fragmentation that characterize much of the medical and long term care financing and delivery systems. Integrated health care systems are hard to implement in rural settings because of the lack of money and experience in managed care. But training and proper investments can help to bring integrated health care to rural areas and provide the aging population with better, cost-efficient care and provide the enrollee who needs the care more choice and a feeling of independence about what they need, and allowing family’s to feel better about the care their loved ones are receiving.

1) Center for Health Care Strategies, Inc. (2005 Dec, 8). Retrieved April 4, 2009, from,
http://www.chcs.org/info-url3969/info-url_show.htm?doc_id=326796

2) Long Term Care-Confronting Today's Challenges. (2003). Academy of Health. Retrieved April 4, 2009, from
http://www.academyhealth.org/files/publications/ltcchallenges.pdf

3) Long Term Care. (2009, March 25). Centers for Medicaid and Medicare Services. Retrieved April 4, 2009, from
http://www.medicare.gov/LongTermCare/static/Home.asp.

4) Coburn, Andrew F, PhD. Models for Integrating and Managing Acute and Long Term Care Services in Rural Areas. Retrieved April 4, 2009, from http://muskie.usm.maine.edu/Publications/rural/ExecSums/%2320.pdf.