Background
Many chronic illnesses and other health conditions—such as heart disease, cancer, multiple sclerosis, arthritis, diabetes, and emphysema—can result in functional limitations. Some acute conditions can also cause functional limitations.
Long-term services and supports (LTSS) needs vary by condition. Individuals may need both nursing care and assistance with activities of daily living and instrumental activities of daily living. Health insurance covers primary care and treatment of acute medical conditions. However, it does not cover LTSS, such as personal care, adult day care, homemaker services, or transportation. Thus, many frail older adults lack the services and supports they need to function independently at home.
For people with chronic conditions, timely preventive and primary health care can reduce the development of functional limitations. Timely care for acute conditions can do the same. For example, immediate treatment for people who have early symptoms of a stroke is crucial. Comprehensive rehabilitation services can also lessen the severity of functional limitations.
For people with both health and long-term services and supports (LTSS) needs, navigating multiple systems of care can be difficult. Lack of coordination among health and LTSS providers can result in suboptimal care.
An increasing number of programs and health plans are starting to recognize the benefit of offering a full range of medical and supportive services, as well as devising better ways to coordinate these services (see also Chronic-Care Coordination and Accountable Care Organizations for approaches to improving care for people with multiple chronic illnesses and Managed Care for Dually Eligible Medicaid Beneficiaries.)
The Center for Medicare & Medicaid Innovation (CMMI) supports efforts to integrate medical and supportive services. CMMI is testing new payment and service delivery models that have the dual goal of reducing Medicare and Medicaid expenditures while preserving or enhancing quality of care. CMMI is also authorized to test new financing models that improve care integration, particularly for individuals eligible for both Medicare and Medicaid (dual-eligibles). These innovations may address some of the issues facing people who receive services through both programs and thus have to navigate two separate and complex delivery and financing systems.
Some service models integrate funding sources so that individuals do not have to navigate separate systems to obtain both health care and LTSS. Integrated financing options for people eligible for both Medicare and Medicaid (known as dual-eligibles or duals) include the Program of All-Inclusive Care for the Elderly, also known as PACE, and dual special-needs plans available through Medicare Advantage plans.
COORDINATION OF HEALTH AND LONG-TERM SERVICES AND SUPPORTS: Policy
COORDINATION OF HEALTH AND LONG-TERM SERVICES AND SUPPORTS: Policy
Coordination and integrated financing of services
Federal and state governments should develop comprehensive, coordinated approaches to financing and delivering care to individuals whose needs are currently met through multiple service systems.
Federal and state governments should actively incorporate the needs of family caregivers in developing new financing and care delivery models that focus on coordination and quality improvement.
Evaluations are needed to identify specific financing mechanisms and delivery systems to serve subgroups of chronically ill individuals who need both ongoing medical care and long-term services and supports. This includes people with physical impairments, mental impairments, or both, as well as those eligible for Medicare and Medicaid (see also Medicare).