Care for Seniors through Health Care Reform

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1 Transforming the Continuum of Care for Seniors through Health Care Reform 11:00 am 12:15 pm Gretchen Alkema, PhD The SCAN Foundation

2 Transforming the Continuum of Care for Seniors through Health Reform Gretchen E. Alkema Vice President, Policy & Communications The SCAN Foundation California Hospital Association Annual Meeting Huntington Beach, CA October 29, 2010 The SCAN Foundation Overview Funding Priority #1: Public Engagement Renovating Language Raising Public Awareness Funding Priority #2: Advancing Realistic Policy Options Financing Delivery Workforce Funding Priority #3: Promising Programs Center for Technology and Aging ( Annual Themed RFP

3 US Life Expectancy (all groups) years years years Source: Adapted from National Center for Health Statistics National Vital Statistics Service Reports 2006 Projected Growth of Older Adult Population, Particularly Those ) Tota al U.S. Population (in millions) and Older Fiscal Year Source: US Census data

4 Medicare Spends Almost 4.5 Times More Per Person on Elders with ADL Needs 2005 per Ca pita Medicare Parts A and B Sp pending $20,000 $16,000 $12,000 $8,000 $4,000 $0 $4,289 $14, and older with 0 ADLs 65 and older with 1+ ADLs $18, and older with 3+ ADLs Source: Avalere analysis of Medicare Current Beneficiary Study 2005 Access to Care data Of all seniors who live alone, roughly 26% have difficulty with activities of daily living and/or cognitive impairment Source: Avalere analysis of 2006 Health and Retirement Study

5 Dual eligibles are 17% of the Medicare population, but represent 28% of Medicare beneficiaries with 5 or more chronic conditions 17% 28% Medicare Only Dual Eligible Medicare Only Dual Eligible 83% Percent of Total Medicare Population (N=45 million) 72% Percent of Medicare Population with 5 or More Chronic Conditions (N=585,740) Source: Avalere analysis of 2008 Medicare claims data Disabling conditions more prevalent among dual eligibles than Medicare only beneficiaries Source: Avalere analysis of 2008 Medicare claims data

6 Daily Assistance Needs: % of individuals 65+ today will need some assistance with personal care and supportive services Most will need an average of 3 years of assistance 20% of these will need assistance for 5 years or more 40% of those needing personal care and supportive services are ages 18 64

7 Core Elements of an Ideal Continuum of Care Strong person centered care based in an accountable primary care setting Multi disciplinary care teams to coordinate full range of medical, behavioral, and long term supports and services (LTSS) needs Comprehensive provider network capable of meeting full range of needs Enhanced use of home and community based services Robustdatasharing sharing andinformation systems Strong consumer protections Financial alignment to drive integration of care Key ACA Opportunities Improving the continuum of care Community based systems change CLASS Act Medicaid options to expand LTSS And much more

8 ACA Continuum of Care Provisions CMS Center for Medicare and Medicaid Innovation (CMI) Goals: Incentives to empower/increase provider accountability and values Improve care coordination across providers and settings Slow growth in federal spending Types of Programs: Innovative care delivery dli and payment models dl Medical/health homes Comprehensive geriatric assessments and care planning Connected technologies ACA Continuum of Care Provisions Federal Coordinated Health Care Office (CHCO) Better alignment of policies for duals Enhance linkages between health and long term care Improve quality of care Smooth transitions between settings Collaboration with Innovation Center, MedPAC, and MacPAC

9 Key Community Based System Change Provisions Agingand Disability Resource Centersexpansion expansion Recent federal grants to states: Options counseling support (20 states) Money Follows the Person (24 states) Evidence Based Care Transitions (16 states) Community Living Assistance Services and Supports (CLASS) Act New voluntary, federally administered long term care insurance program Working individuals eligible Guarantee Issue 5 year vesting period Premiums rated by age Cash hbenefit at 2 3 Atiiti Activities of Dil Daily Living i dfiit deficits No taxpayer dollars to support program

10 Key Medicaid HCBS Provisions Community First Choice Option: Createsstate state planhcbs optionfor peopleneeding institutional level of care States eligible 6% enhanced federal match State Balancing Incentives Payments Program Temporarily federal match increase to get states spending at least 50% of Medicaid dollars on HCBS Money Follows the Person Demonstration Extension Modifies eligibility criteria to increase program access More ACA Provisions of Interest Medicare shared savings program (ACOs) Acute/post acute acutebundling pilots Quality improvement next steps Lots of demos (e.g., hospice concurrent care, Independence at Home) Medication management Spousal impoverishment protections for Medicaid HCBS Training health care workforce Nursing home transparency and improvement

11 What does this mean for you? See yourself as part of a broader system of care Evaluate quality of care and quality of life outcomes Think and act beyond the curb The SCAN Foundation s mission is to advance the development of a sustainable continuum of quality care for seniors. The SCAN Foundation s vision is a society where seniors receive medical treatment and human services that are integrated in the setting most appropriate to the their hi needs and with the greatest likelihood of a healthy, independent life. For more information and to receive alerts, Please visit us at

12 Thank you. Gretchen Alkema, PhD The SCAN Foundation (562) Questions