DorlandHealth

Since 1995 an initiative known as Cash and Counseling has been beckoning a long-term care transformation. Centered around a concept called consumer direction, these programs, along with similar ones they have inspired, promote a new way of looking at long-term care service options for the disabled, the developmentally impaired and others in need of support. In short, they stand as power brokers, displacing traditional modes of service provision and increasing the control of such services for the patients who require them.

“These are service delivery models designed to empower people with chronic disabilities and their families,” says Pamela Doty, a senior policy analyst with the Office of the Assistant Secretary for Planning and Evaluation with the Department of Health and Human Services. Doty was the lead author of New State Strategies to Meet Long-term Care Needs, a study on consumer direction that appeared in a recent issue of policy journal Health Affairs. “They gain considerably more choice and control over the who, what, where, when of their home and community-based long-term services and supports than they would have in a more traditional ‘provider-driven’ system,” she continues.

The question is, what role does case management play in this new framework? And where there are fissures, can traditional case management and consumer-directed models of care work together equitably? First, let’s take a deeper look  into what consumer direction really is.

A relatively new concept, at least in practical application in the U.S., consumer-directed services took root in the mid-1990s when the Robert Wood Johnson Foundation commissioned a controlled experiment to test the idea, which was basically to give consumers, or patients, control over a budget for which they could research and procure the services necessary to their situation. This, instead of an agency performing an assessment, monitoring and judging need.

Richard Scott

There are nearly 40,000 assisted living facilities across the country, but depending on where you live you may be hard-pressed to find one. A new report from Harvard Medical School researchers shows that the availability of assisted living facilities largely depends on socioeconomic demographic information like wealth and home value.

In Sizing Up the Market for Assisted Living, a report published in Health Affairs, authors David Stevenson and David Grabowski have scoured state and regional locations to provide a comprehensive look into the assisted living landscape—what has been a sorely understudied area despite the booming popularity of the services themselves.

From 1999 to 2007, which is the most recent year of available data, the number of facilities has increased roughly threefold, from 12,000 to more than 38,000. The number of beds hover around 1 million. While assisted living facilities have not displaced nursing homes, they are eating up market share, and the majority of consumers reportedly prefer them over the less formalized nursing homes, according to one study.

Richard Scott

The final step toward the passage of a comprehensive health care reform bill is underway. Presently Congress is debating the two voluminous pieces of legislation that have passed in the House and the Senate respectively. The two bills contain both major and minor discrepancies that lawmakers will need to approach, evaluate, dissect and meld into one before a final bill is put up for the most decisive vote on health care legislation in more than four decades.

While deep ideological divides remain among individual members and national parties, experts expect a bill, in some shape or form, to pass in late January. In the meantime, the key differences between the bills will take center stage in formal proceedings and—all too likely—behind closed doors. The following is a comparison of seven issues that legislators will need to reconcile to achieve a unified bill.

Individual mandate. Both bills call for a requirement of coverage along with imposed penalties for not having coverage, but their methods vary. The Senate bill would fine a flat rate of at least $750 or 2 percent of household income when it is fully phased in (2016), whichever is more. The highest penalty would be $2,250. The House bill solely charges a percentage penalty of 2.5 percent above the filing threshold. The threshold is currently $9,350 for individuals and $18,700 for couples. The penalty cannot exceed the cost of the average national premium.

Richard Scott

Entering the new year, case managers and other health care professionals can expect to see a wide variety of changes to the health care landscape. A recently issued top 10 list from Pricewaterhousecoopers’ Health Research Institute pinpoints the new year’s coming attractions—and difficulties. The aftereffects of health reform, the remnants of the lingering recession, the newly adopted payment policies, and the increasing breadth of penalties for fraud and abuse comprise just part of what health care practitioners across the spectrum can expect to see.

“The government is taking a more active role in demanding quality and managing costs, the recession has pinched budgets, and both new and existing players are examining the value they bring to consumers,” reads an introductory passage to the report, titled Top 10 health industry issues in 2010: Squeezing the juice out of health care.

The need for case management departments to show their value is heightened in light of the report’s projections, as providers and payers will seek to control costs and create more efficient bodies. The report goes on to say, “The potential for savings multiplies as the industry converges, squeezing out inefficiencies and duplication. Health leaders must look beyond their own organizations and figure out how they can benefit by reducing costs elsewhere in the value chain.”

Richard Scott

In the early morning on Christmas Eve, the U.S. Senate convened to hold a vote on a landmark measure of health reform—H.R. 3590, or The Patient Protection and Affordable Care Act. Following a strict party-line vote of 60-39 the bill passed as the most comprehensive public health reform effort since the creation of Medicare in 1965.

Now slated for debate following the new year, the bill, or some form of it, will likely pass in January. This week, Case In Point Weekly sat down with Dr. Georges C. Benjamin, executive director of the American Public Health Association, to explore the potential ramifications of the bill, what it means for public health, and where the APHA stands on some of its key measures.

Richard Scott: Recently the APHA urged Congress to move forward with health reform. Why the urgent call now? 

Georges Benjamin: Each over year 44,0000 people die prematurely because they do not have health insurance, over one half of all individual bankruptcies are due to  health care costs, and about 100,000 people die unnecessarily because of medical errors. We pay twice as much as other industrialized nations and get poorer results for our population as a whole. The irony is, for many in the system we give the best care in the world but for others it is fractured and most inefficient.  We also have a system that is unevenly balanced toward sick care and not prevention. Congress must act now to stop this national tragedy.

RS: Is the Senate bill fit for passage? If so, why [was] it being held up?

GB: The Senate Bill is overall a good bill. However there are some provisions we do not like at all, like the increased restrictions on women’s rights to choose and others that can be strengthened like the affordability provisions and the absence of a real mechanism to force competition with the insurance industry (a public plan). It was being held up because of profound ideological differences between and within the parties, the opportunity for political deal making by some, and the complexity of the legislative process in the Senate (requirement to get a super majority, i.e. 60 votes).