Currently Viewing:
The American Journal of Managed Care November 2016
Referrals and the PCMH: How Well Do We Know Our Neighborhood?
Andrew Schreiner, MD; Patrick Mauldin, PhD, Jingwen Zhang, MS; Justin Marsden, BS; and William Moran, MD, MS
Does Medicare Advantage Enrollment Affect Home Healthcare Use?
Daniel A. Waxman, MD, PhD; Lillian Min, MD, MSHS; Claude M. Setodji, PhD; Mark Hanson, PhD; Neil S. Wenger, MD, MPH; and David A. Ganz, MD, PhD
A New Chapter in Health Reform
Michael E. Chernew, PhD, and A. Mark Fendrick, MD
Prescribers' Perceptions of Medication Discontinuation: Survey Instrument Development and Validation
Amy Linsky, MD, MSc; Steven R. Simon, MD, MPH; Kelly Stolzmann, MS; Barbara G. Bokhour, PhD; and Mark Meterko, PhD
Enhancing Patient and Family Engagement Through Meaningful Use Stage 3: Opportunities and Barriers to Implementation
Jaclyn Rappaport, MPP, MBA; Sara Galantowicz, MPH; Andrea Hassol, MSPH; Anisha Illa, BS; Sid Thornton, PhD; Shan He, PhD; Jean Adams, RN, ACIO; and Charlie Sawyer, MD, FACP
Currently Reading
Integrated Care Organizations: Medicare Financing for Care at Home
Karen Davis, PhD; Amber Willink, PhD; and Cathy Schoen, MS
Health Systems Tackling Social Determinants of Health: Promises, Pitfalls, and Opportunities of Current Policies
Krisda H. Chaiyachati, MD, MPH; David T. Grande, MD, MPA; and Jaya Aysola, MD, DTMH, MPH
Maternal Mental Health and Infant Mortality for Healthy-Weight Infants
Susan E. White, PhD, RHIA, CHDA, and Robert W. Gladden, MA, BS
The Role of Internal Medicine Subspecialists in Patient Care Management
Jonathan L. Vandergrift, MS; Bradley M. Gray, PhD; James D. Reschovsky, PhD; Eric S. Holmboe, MD; and Rebecca S. Lipner, PhD
Medical Home Transformation and Breast Cancer Screening
Amy W. Baughman, MD, MPH; Phyllis Brawarsky, MPH; Tracy Onega, PhD, MS; Tor D. Tosteson, ScD; Qianfei Wang, MS; Anna N.A. Tosteson, ScD; and Jennifer S. Haas, MD, MSc

Integrated Care Organizations: Medicare Financing for Care at Home

Karen Davis, PhD; Amber Willink, PhD; and Cathy Schoen, MS
This paper presents a policy proposal to integrate care for Medicare beneficiaries through creation of integrated care organizations and a Medicare home care benefit.
Several important caveats should be noted. First, the numbers of Medicare beneficiaries will grow over time, including those with physical and/or cognitive limitations, subsequently increasing the cost of care over time. Some Medicaid beneficiaries may opt for coverage under Medicare rather than Medicaid given serious restrictions on eligibility and home- and community-based benefits in many states. Further, there may be adverse risk selection with beneficiaries at greater risk of requiring LTSS being more likely to participate than those with lower risk. Low-income individuals with lower cost sharing are also more likely to participate than high-income beneficiaries who are required to pay 50% of the cost of services. However, the fact that there is a severe penalty for failing to enroll at the time of Medicare eligibility, and the substantial financing provided by payroll taxes are likely to be significant deterrents to forgoing the benefit, as has been the experience with Part B of Medicare.

Conclusions

ACOs will increasingly grapple with the need for LTSS among their aging patients. Financing home- and community-based services under Medicare and expanding ACOs to be accountable for LTSS would provide the incentive and means to coordinate care, support family care partners, and better meet beneficiary preferences for independent living and care at home. It would also reduce beneficiary reliance on Medicaid’s safety net coverage of institutional care. This policy proposal is worthy of serious consideration as the nation grapples with the need for Medicare redesign to meet the needs of an aging population. It could serve as an important first step toward more far-reaching Medicare benefit redesign proposals to improve the affordability of services. Unlike Medicare’s original focus on inpatient hospital care, it recognizes that many services can be provided in noninstitutional settings, including the home, and realigns benefits to provide care in a way that meets beneficiary preferences. 

Author Affiliations: Johns Hopkins Bloomberg School of Public Health (KD, AW), Baltimore, MD; New York Academy of Medicine (CS), New York, NY. 
 
Source of Funding: The Commonwealth Fund.
 
Author Disclosures: Dr Davis is on the Board of nonprofit Geisinger Health (without compensation). The remaining authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article. 
 
Authorship Information: Concept and design (KD, CS); acquisition of data (AW); analysis and interpretation of data (KD, CS, AW); drafting of the manuscript (KD); critical revision of the manuscript for important intellectual content (KD, CS, AW); statistical analysis (AW); obtaining funding (KD); administrative, technical, or logistic support (KD, AW); and supervision (KD). 
 
Address Correspondence to: Karen Davis, PhD, 624 N. Broadway, Room 693, Baltimore, MD 21205. E-mail kadavis@jhsph.edu.
REFERENCES

1. Blumenthal D, Davis K, Guterman S. Medicare at 50—origins and evolution. New Engl J Med. 2015;372(5):479-486. doi: 10.1056/NEJMhpr1411701.

2. Wolff JL, Spillman B. Older adults receiving assistance with physician visits and prescribed medications and their family caregivers: prevalence, characteristics, and hours of care. J Gerontol B Psychol Sci Soc Sci. 2014;69(suppl 1):S65-S72. doi: 10.1093/geronb/gbu119.

3. National health expenditure projections 2015-2025. CMS website. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsProjected.html. Accessed May 2016.

4. CMS Medicare Current Beneficiary Survey cost and use file 2012 [data file]. CMS website. https://www.cms.gov/Research-Statistics-Data-and-Systems/Files-for-Order/LimitedDataSets/MCBS.html. Accessed January 2016.

5. Davis K, Willink A, Schoen C. Medicare help at home. Health Affairs website. http://healthaffairs.org/blog/2016/04/13/medicare-help-at-home/. Published April 13, 2016. Accessed April 2016.

6. Wolff J, Davis K, Leeds M, Narawa L, Stockwell I, Woodcock C. Family caregivers as paid personal care attendants in Medicaid. Johns Hopkins Bloomberg School of Public Health website. http://www.jhsph.edu/research/centers-and-institutes/roger-c-lipitz-center-for-integrated-health-care/issue-brief-family-caregivers.html. Accessed October 2016

7. Sommers B, Kronick R, Finegold K, Po R, Schwarts K, Glied S. Understanding participation rates in Medicaid: implications for the Affordable Care Act. Office of the Assistant Secretary for Planning and Evaluation website. https://aspe.hhs.gov/basic-report/understanding-participation-rates-medicaid-implications-affordable-care-act. Published March 16, 2012. Accessed March 2016.

8. Options for reducing the deficit: 2015 to 2024. Congressional Budget Office website. https://www.cbo.gov/budget-options/2014. Published November 20, 2014. Accessed April 2016. 

9. Davis K, Buttorff C, Leff B, et al. Innovative care models for high-cost Medicare beneficiaries: delivery system and payment reform to accelerate adoption. Am J Manag Care. 2015;21(5):e349-e359. 

10. Affordable Care Act payment model continues to improve care, lower costs [press release]. Baltimore, MD: Center for Medicare and Medicaid Services; August 9, 2016. https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2016-Press-releases-items/2016-08-09.html. Accessed October 2016.

11. Leff B, Burton L, Mader SL, et al. Hospital at home: feasibility and outcomes of a program to provide hospital-level care at home for acutely ill older patients. Ann Intern Med. 2005;143(11):798-808. 

12. Szanton SL, Leff B, Wolff JL, et al. Home-based care program reduces disability and promotes aging in place. Health Aff. 2016;35(9):1558-1563. doi: 10.1377/hlthaff.2016.0140.

13. Samus QM, Johnston D, Black BS, et al. A multidimensional home-based care coordination intervention for elders with memory disorders: the Maximizing Independence at Home (MIND) Pilot randomized trial. Am J Geriatr Psychiatry. 2014;22(4):398-414. doi: 10.1016/j.jagp.2013.12.175.
PDF
 
Copyright AJMC 2006-2019 Clinical Care Targeted Communications Group, LLC. All Rights Reserved.
x
Welcome the the new and improved AJMC.com, the premier managed market network. Tell us about yourself so that we can serve you better.
Sign Up