In exploring integration of acute and long-tern care, this book
begins by characterising the dually eligible population, and
describing problems associated with meeting their health and social
service needs in an uncoordinated system. It continues by analysing
the advantages of using capitation and care management as a vehicle
for integrating those services, and by discussing concerns about
care integration strategies. It concludes by profiling nine federal
and state programs that to varying degrees, integrate the acute and
long-term care services that people who are dually eligible for
Medicare-Medicaid, often require. They are: Federal initiatives
such as the Program for All-inclusive Care of the Elderly (PACE),
which capitates both Medicare and Medicaid acute and long-term care
services for those who are dually eligible, and the Social/Health
Maintenance Organization (S/HMO) and EverCare demonstrations, which
capitate Medicare benefits only; Comprehensive state demonstrations
such as Minnesota Senior Health Options, the Wisconsin Partnership
Program, and the Continuing Care Network Demonstration of Monroe
County, New York, which, like PACE, capitates both Medicare and
Medicaid benefits; and Capitated state Medicaid demonstrations such
as the Arizona Long-Term Care System, Oregon Health Plan, and
Florida's Community-Based Diversion Pilot Project, which capitate
Medicaid only, but actively pursue various Medicare co-ordination
strategies. Proposals that explore using care management techniques
to integrate Medicare and Medicaid services delivery, without
capitation, are also discussed briefly. The book concludes with the
observation that although federal and state initiatives to
integrate acute and long-term care for those who are dually
eligible, only serve a relatively small percentage of this
population, they provide a set of options which Congress may want
to examine when formulating long-term care policy in the future.
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