The Real Story Behind The Latest Hospice Controversy

The Washington Post published an extensive investigative story on hospice the other day. The take away: Hospices (mostly for-profits) are making big bucks by manipulating their case loads to maximize Medicare payments. In short, they are taking on many patients who are frail but not dying and thus staying on hospice care for a very long time.

But the Post article misses a bigger question:  Why are growing numbers of people willing to enroll in hospice—and often forego traditional medical treatment– long before they are dying? Part of the reason may be because they thrive on the care hospice provides—care they rarely can get anywhere else in our medical system.

The Boom in Medicare Managed Care

Despite the fears of consumer advocates and the predictions of many insurance companies, seniors are flocking to Medicare Advantage managed care plans. It shouldn’t be a surprise since premiums for these policies are a fraction of the cost of traditional fee-for-service Medicare.

This shift may be one driver of the recent slowdown in the growth of health care costs and it may open the door to even bigger changes in the way both medical and long-term supports and services are eventually delivered.

Three New Health Reform Plans Ignore the Long-Term Care Needs of Seniors and People with Disabilities

In the past few weeks, no fewer than three highly respected groups have proposed major health care reforms. They all promise greater use of patient-centered integrated care, but none include supports and services for frail elders or younger people with disabilities.

It took four decades to incorporate a drug benefit into Medicare. Now we seem to be in the same place with supports and services for people with chronic disease. If you were building a health system from scratch, you’d never leave out the non-medical assistance people need to help manage chronic illness—say, help with personal hygiene.

California Will Shift 456,000 Low Income Seniors into Managed Care

California has taken the idea of managed care for low-income seniors and people with disabilities to a whole new level. Under an agreement with the Obama Administration announced last week, the state will begin shifting both medical care and long-term supports and services to managed care companies in just seven months.

Watch this closely. You may be looking at the future.

For a fixed, per-patient monthly rate, those firms will be responsible for providing the full spectrum of care to people who have few assets and little income, but who often require extensive levels of care. The program, called Cal MediConnect, will cover people who receive benefits from both Medicare and Medicaid (called Medi-Cal in California)—thus often called dual eligibles.

How Teamwork Across the Health System Can Keep Seniors Out of the Hospital

Broad-based, integrated, community-wide initiatives can help keep seniors out of the hospital, says an important new study from the Journal of the American Medical Association.

The study, done by a team led by Dr. Joanne Lynn of the Altarum Institute’s Center on Elder Care and Advanced Illness is new evidence that by working together, hospitals, physicians, social workers, nursing homes, home health agencies, and community organizations can help seniors reduce both initial hospitalizations and readmissions. This suggests that such teamwork can improve the quality of care for elders with chronic disease.

The Promise and Risks of Medicare Managed Care

In 2012, about 13 million seniors participated in Medicare Advantage (MA) managed care plans—about 27 percent of the Medicare population and twice as many as were enrolled just seven years ago.

This rapid shift to managed care by seniors may be just a first step towards a fundamental change in the way Medicare is delivered and financed. And it has the potential to transform the way long-term supports and services are provided as well.

What Is Person-Centered Care, and Does It Work?

Patient-centered care (as it is described by doctors) or person-centered care (the phrase-more frequently used in non-medical settings) is one of those concepts everyone supports–except when it comes to the details. On Nov. 8-9, I’ll be participating in a two-day symposium sponsored by the Samueli Institute aimed at breaking down the barriers between the medical and non-medical world and seeking evidence to show the benefits of patient (or person) centered care.

Hill Panel Debates Managing Care for Dual Eligible Seniors

Everybody wants to do a better job coordinating care for the frail elderly and younger adults with disabilities who have extensive medical and personal care needs. But just how to do it is becoming increasingly controversial—especially on Capitol Hill.

The current flashpoint is an aggressive new Obama Administration initiative aimed at improving care and cutting costs for those who are very poor and very sick. There are 9 million of these so-called dual eligibles receiving benefits through both Medicare and Medicaid.

Private Insurers are Betting Big on Managed Care for “Dual Eligible” Seniors

Insurance giant Wellpoint is the latest carrier making a big bet on managing care for those seniors and adults with disabilities who are eligible for both Medicare and Medicaid.  About 9 million people, called “dual eligibles” receive benefits from both programs. They are both very poor and very sick and often have significant needs for personal assistance.

Medicaid alone spends $145 billion a year to care for them—most for long-term care services—while Medicare spends $175 billion on medical care for this population. The frail elderly, who have both multiple chronic diseases and personal care needs, are both the most expensive and the most difficult to care for.

Frail Seniors are Most At-Risk and Costliest to Treat

People often say that the patients most at risk in the U.S. health system are the elderly who suffer from multiple chronic diseases. But it may be that a subset of these seniors—those with chronic disease who also need personal assistance with routine activities—are in the most jeopardy.

An important 2011 research paper finds they are the most costly to care for.  Only about 15 percent of the total Medicare population suffers from 3 or more chronic diseases and faces functional limitations. But these very frail–mostly elderly–people account for 32 percent all Medicare spending, according to Harriet Komisar and Judy Feder of Georgetown University (Judy is also a colleague of mine at The Urban Institute).