Why managed care is good for long-term care

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Joseph Healy
Joseph Healy
New York is embarking on a historic reform effort to overhaul our state's Medicaid program — for years it has ranked among the nation's largest and most expensive of its kind — by requiring that all long-term care patients be enrolled in a managed care program.

The shift to managed long-term care, which closely follows the direction of federal healthcare reform, holds great promise for the patients we serve.  

For these patients and their families, managed long-term care brings “one-stop shopping” to their healthcare. 

Because these patients usually have complex medical needs, the healthcare services they access are often located outside of the traditional hospital and nursing home settings, which means they are extremely fragmented and sometimes inconvenient to access.

For the families of long-term care patients, trying to coordinate their care — physician appointments, home healthcare, treatment protocols for multiple conditions, medication interactions and recovery monitoring — is a full time job.

And most of the time, healthcare providers caring for these patients are not compensated to coordinate their care or to ensure that the patient's quality of life is the best it can be; most of them are reimbursed on a fee-for-service basis.

Managed long-term care offers a solution to all of these challenges.

Our managed long-term care organization is, first and foremost, a provider organization. More than 850 of our 1,000 employees are directly involved in the delivery of care for our patients. We do more than administer a benefit to our patients: We put the patients first and we care for them day in and day out.

We coordinate every aspect of our patients' care, ranging from finding a primary care physician to securing transportation to accessing rehabilitation services. And, we work with their family members to share information, track results and ensure that these patients are living the best lives they can.

Because we are with our patients each step of the way and keenly aware of their condition, patients get the right kind of care … at the right time and in the right place. Our patients stay home longer, have shorter hospital stays and access the ER less.

What is good for our patients is also good for our organization. Because patients are getting the right kind of care – care that is appropriate for their medical conditions – there are naturally occurring costs savings.

Consider a 2010 Lewin Group study of the New York Medicaid program, which showed that managed long-term care can treat more people in a cost-effective way. For managed long-term care, the number of patients in the program increased 143.9 % over a five year period, while per recipient spending – that's how much is spent on each member – decreased .4 %.

Fee-for-service long-term care, on the other hand, proved expensive, yet served fewer people each year. During the same time frame, per-recipient spending on fee-for-service long-term care increased 50%, yet the number of recipients enrolled in the program decreased 9%.

Cost savings are an added benefit, but not the most important goal of reform. 

The patient and what's good for him or her is what's most important. For them, managed long-term care takes complex issues off the table and helps patients get the kind of care they need, where they need it, while staying in their homes and communities.

Joseph M. Healy, Jr., PhD, is the chief operating officer at CenterLight Healthcare.

  

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