For decades, seniors and others with chronic illness have had to scale a seemingly insurmountable barrier built by the health care system, aided and abetted by Medicare and Medicaid. On one side of the wall was medical care, mostly controlled by doctors, hospitals, drug companies, and skilled nursing facilities. Medicare paid them to do as many medical procedures as possible, and [...]
For an important clue into the future of senior care in the U.S., watch Kindred Healthcare, a $5 billion company that operates in 47 states. As recently as 2010, half of Kindred’s business was generated by its skilled nursing facilities. This year, only one-fifth of its revenues will come from its nursing and rehab centers. In a major strategic shift, [...]
The loud debate over how many people have gotten health insurance under the Affordable Care Act misses the point. Yes, reducing the number of uninsured was one goal of the ACA. But only one. The law’s most enduring legacy will come from its historical—but largely unnoticed—changes in the way health care is delivered. Unlike the insurance expansion, which largely excludes Medicare, many [...]
The most important trend in care for the frail elderly and younger people with disabilities may be what’s called managed long-term supports and services, or MLTSS. This effort to combine medical care with long-term care would replace today’s disorganized, ineffective, and even dangerous system with one that can bring together complex care that’s being delivered by many different providers. Done [...]
A new Medicare payment model would encourage health systems to provide fully-integrated medical care for people with chronic disease, according new bipartisan legislation sponsored by senators Ron Wyden (D-OR) and Johnny Isakson (R-GA), and congressmen Erik Paulsen (R-MN) and Peter Welch (D-VT). The measure would allow, but not require, participating providers to offer long-term services and supports as well as medical [...]
Baby Boomers are in serious denial when it comes to their medical and long-term care costs in retirement. Yes, Medicare provides excellent health insurance (subsidized in large part by taxpayers). But it doesn’t come close to paying for a senior’s medical costs. And doesn’t pay for long-term supports and services at all. Those holes in the Medicare system mean a [...]
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 [...]
The New Year's budget agreement to avoid the fiscal cliff includes two key measures that could be critical to people receiving long-term supports and services and their caregivers. The first repeals the Community Living Assistance Services and Supports (CLASS) Act. The second creates a new national commission to develop a plan for better financing and delivery of long-term care services. Unfortunately, there may be [...]
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 [...]
With the presidential election in less than two weeks, consumers, advocates, and providers should pay attention to what Barack Obama and Mitt Romney would do about long-term supports and services for the frail elderly and younger people with disabilities. It is hard to know for sure, because neither man has said much. Yet, between the lines, there are important messages. [...]