Medicaid Managed Care: Background, Issues, and Options

Managed care is a fundamental shift from the historical fee-for-service payment systems. It provides opportunities for states to transform the delivery and financing of Medicaid financed services and promote and reward improved care outcomes. Implementation of such programs requires thoughtful planning, active stakeholder engagement and an effective administrative infrastructure to manage and operate in a value based purchasing environment

Can Mainers Afford to Pay for Long-term Care as the Baby Boom Generation Ages?

Long-term care services for older adults represent a significant share of total health care spending and this share is expected to increase as the baby boom generation continues to age. Unlike the broad coverage provided for other kinds of health care services, private insurance policies and Medicare cover only a small portion of total long-term care services

Housing and Service Options for Older Adults in Maine

Older adults want to live at home and in their community as independently as possible for as long as possible (Bayer & Harper L, 2000). The housing and service needs of older adults vary greatly by age, by condition, by setting, by geographic region, and over time. Some older adults do not require any supportive services; others need services that may range from assistance with shopping to extensive need for nursing care. Needs also fluctuate in response to acute events (often requiring hospitalizations), or other temporary changes in health status. The challenge is to have a mix of private and publicly funded housing and service options available that can meet the variety and changing needs of older adults. Certain groups have special needs. Meeting the needs of people with Alzheimer’s and dementia, for example, is particularly challenging due to the duration and complexity of the disease process. In some instances these needs can successfully be met at home, and in other instances the needs are best met in an alternate setting e.g. residential or nursing facility with specially trained staff. People at the end of life also have special needs such as pain management and emotional or spiritual support. In all instances, caregivers and family members are integral to successfully meeting the needs of older adults. Many factors influence the supply and the demand for housing, services, and supports. In the last decade, the demand for institutional long term care has remained stagnant as other community based options have developed (Kochera, Straight, & Guterbock, 2005). The supply of independent and assisted living options has grown significantly to meet the increased demand. Furthermore, recent studies have shown that older adults are healthier and have fewer disabilities than in prior decades (Spillman, 2004) (Waidmann & Liu, 2000). The implications of a healthier older population that lives longer and the impact on housing and services needs are not fully known

Financing and Payment Issues in Rural Long-term Care Integration [Policy Brief]

Federal and state policy makers, consumers, health plans, providers, and other stakeholders are interested in the benefits and disadvantages of integrating acute and long term care financing in rural areas. To date, experience with integrated financing is limited and is based largely in urban areas. This paper reviews current research and experience and identifies key policy and program considerations for integrated financing in rural areas

Financing and Payment Issues in Rural Long-term Care Integration [Working Paper]

Federal and state policy makers, consumers, health plans, providers, and other stakeholders are interested in the benefits and disadvantages of integrating acute and long term care financing in rural areas. To date, experience with integrated financing is limited and is based largely in urban areas. This paper reviews current research and experience and identifies key policy and program considerations for integrated financing in rural areas

Quality Indicators for Home and Community-based Services [Working Paper]

In 2001, the Maine Department of Human Services received a three year grant from the U.S. Department of Health and Human Service to improve services for people with disabilities. This grant was part of the Real Choice Systems Change Initiative funded by the Centers for Medicare & Medicaid. The grant funded work in four major areas: Person-centered services, Quality, Access, and Data Integration

Compendium of Quality Indicators: Older Adults, Adults with Physical Disabilities, Adults with Mental Retardation/Autism Living at Home, in the Community or in Long Term Care Facilities

Researchers at the Muskie School of Public Service compiled over 15 tools and surveys. Included in the report are Participant Experience Surveys, Performance Indicators, Experience Surveys, Core Indicators, Consumer Surveys, Behavioral Risk Factors, Outcome Measures, and a variety of Quality Measures. Sample questions and tools are shown in this Compendium of Quality Indicator

Using System Level Quality Measures to Improve Home and Community-based Services in Maine

The purpose of this project was to identify a set of quality measures that could be used to profile the performance of Maine’s home and community based care (HCBS) system. The long term care system in Maine has been significantly restructured in the last five years. Funding for home care services has more than doubled and now represents approximately 20% of Medicaid and State funding for LTC. This has led to increased interest in assuring the quality of services that are being provided and developing ways to improve the delivery of services and outcomes for consumers. Using assessment data from the Maine MECARE system, residential care facilities and nursing facilities, an initial set of potential indicators was examined. Key stakeholders identified priority areas for quality improvement. The Bureau of Elder and Adult Services identified, prevalence of falls, as the first area to initiate a quality improvement activity. The Bureau of Elder and Adult Services convened a multi-disciplinary group of professionals in Maine to learn more about existing fall evaluation and prevention programs. Using practice guidelines published in the Annals of Internal Medicine, the Bureau is currently examining a number of fall intervention and prevention strategies. This project represented a first step in using long term care assessment data to improve the quality of home and community based services in Maine. Recommendations for future work include: Continue to build support for quality measures through the involvement of key opinion leaders and stakeholder groups. Identify a short list of quality indicators that represent multiple dimensions of quality. Identify at least one chronic condition for a quality improvement activity. Develop, pilot and make available consumer friendly reports to the public on Maine’s home and community based care system Develop a plan to maintain a sustainable and qualified workforce of people who provide home and community based services

Work Book: Improving the Quality of Home and Community-based Services and Supports

The HCBS Work Book is a technical assistance guide to assist state agencies with their HCBS quality improvement efforts. It provides step-by-step guidance on how to conduct quality improvement projects within the HCBS waiver program, and illustrates the principles of quality improvement in an easy to use format. The Work Book was developed for CMS by the Muskie School of Public Service at the University of Southern Maine

Performance Measurement: Managing and Using Home and Community-based Services Data for Quality Improvement

The Data Management and Use Series represents the third in a group of papers synthesizing the ideas and practices of states as they improve the quality of home and community based services (HCBS) and supports for older persons and persons with disabilities