GENERATIONS – Journal of the American Society on Aging

How Will LTSS and Medical Care Integrate to Provide Community-Based Care? By Anne Montgomery and Sarah Slocum

Expanding PACE to other beneficiaries in Michigan, and partnering with a healthcare plan in Indiana.

S ome aspects of the future are impossible to predict, but some are entirely certain, and the upcoming growth of LTSS demand is quite clear. In 2017, spending on long-term services and sup- ports (LTSS) reached $348 billion, a 48 percent increase from 2008, when spending was $235 bil- lion (Open Minds, 2018). An estimated 12 million Americans receive LTSS every year—older adults, individuals with physical disabilities, people with intellectual and developmental disabilities, and others at risk of institutionalization—and, by mid-century, that number will rise to an esti- mated 27 million (Norman, 2013). Managed care already is transforming the Medicaid LTSS market, with twenty-four states in 2017 reporting that they were using managed LTSS plans to serve primarily older adult popula- tions and adults with physical disabilities (Lewis et al., 2018). But the more interesting—and less predictable—part of this story involves new types of partnerships and emerging service delivery

arrangements that the integration of medical care and LTSS is starting to produce, and how these arrangements can benefit communities. This article discusses two scenarios: contracting opportunities for Program of All-Inclusive Care for the Elderly (PACE) or­ ganizations that want to expand their footprint into the Fee-for-Service (FFS) Medicare-only market, a population that can pay for LTSS out- of-pocket; and evolving arrangements from partnerships between Area Agencies on Aging (AAA) and managed care organizations (MCO) that serve commercial and Medicaid popula- tions—and which may expand over the next several years into serving Medicare Advantage (MA) plan enrollees.

MA Flexibility Can Mean Business Opportunities for PACE

Some PACE organizations are starting discus- sions about the types of possible arrangements

abstract The impending growth of long-term services and supports (LTSS) demand is clear. In 2017, LTSS spending reached $348 billion, a 48 percent increase from 2008. An estimated 12 million Ameri- cans receive LTSS every year, and that number will rise to an estimated 27 million by mid-century. Innovative plans and programs are emerging for older adults, a result of integrating LTSS into medical care. This article describes two community-based programs; one expands PACE to other beneficiaries, and another involves the aging network in integrated services arrangements with healthcare. | key words : LTSS, PACE, CHRONIC Care Act, Medicare Advantage plans, Aging & In-Home Services

48 | Spring 2019

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