Addressing the needs of a rapidly growing older population is one of the major challenges facing the United States over the next few decades and an unprecedented opportunity to redesign the current system for delivering health care and long-term services and supports. LeadingAge national recently announced its proposal for reforming the American health care system in a new report, Integrated Service Delivery: A LeadingAge Vision for America’s’ Aging Population.
The report identifies two major failures of the American health care system for older adults:
- The current delivery system offers little guidance to older adults and their families as they attempt to coordinate, navigate and manage our complex and fragmented system of medical care and long-term services and supports. When families tackle this overwhelming challenge alone, it often results in unmet needs, inefficient use of available dollars, and poor outcomes.
- The long-term services and support financing system offers no protection against the severe economic consequences that often accompany the need for expensive services and supports, particularly over long periods.
LeadingAge believes these two failures are related, and offers two recommendations for reform:
- Develop and support an integrated service model for older adults.
- Develop a universal long-term services and supports insurance system to provide important financial support for this integrated service model. (A companion paper from LeadingAge describes the critical need for, and the basic elements of, this new insurance program.)
LeadingAge’s proposed integrated service model’s primary features would include:
Pooled funding and risk sharing: The integrated service model depends on the ability of hub providers to pool all sources of funding – public and personal – and to be free from the existing fee-for-service structure. Hub providers would offer a full range of coordinated services and supports designed to help an individual maintain health and achieve personal goals. Hub providers would assume a portion of the risk for outcomes and total cost of care.
Single point of contact: A single “service facilitator” would work with the older adult, his or her family, and the hub’s interdisciplinary care team to answer questions and identify and coordinate needed services, supports and resources across settings. The facilitator would serve as a liaison between the individual and his or her family and provider hub.
Assessment and single service plan: The hub’s interdisciplinary provider team would conduct a comprehensive assessment of each older adult, and use its findings to develop a universal aging service plan in collaboration with the older adult, his or her family, and all identified care and service providers. The service plan would address all of the older adult’s needs for services and supports, not just his or her medical needs. To meet this broad range of needs, the hub would pool Medicare funds with a variety of other available dollars – such as Medicaid, HUD, Older Americans’ Act dollars and, where available, personal funds – to offer any service or support that optimizes health or functional status for beneficiaries, as long as those services addressed needs identified in the aging service plan.
Comprehensive service coordination: Comprehensive service coordination would be a key strategy for improving outcomes for the older adult, and enhancing the effectiveness of the hub providers. To facilitate this coordination, providers, the hub service facilitator, older adults and families would have real-time access to the individual’s health information and aging service plan. Technology tools would be used to share information, improve access to services and supports, enhance wellness and independence, and facilitate predictive modeling to improve outcomes and identify best practices.
Quality assurance: The integrated service framework would define measures of quality that gauge the satisfaction of the older adult and his or her caregivers. Quality measures would also be tied to achievement of the individual’s goals, as identified in the aging service plan.
Implementation of the comprehensive approach outlined in the report will require widespread reform of systems and payments, as well as a change in our way of thinking about the delivery of health and long- term services and supports. This widespread reform is clearly a long-term goal. Therefore, the report also recommends a menu of interim steps that policy makers could take to move our delivery system toward integration, and incentivize providers to adopt a more holistic approach to the work they do.
For more information or questions/comments, contact Nicole Fallon, Vice President for Health Policy and Integrated Services at LeadingAge national. Email nfallon@leadingage.org. Phone 202-508-9435.
