A Primer on Managed Care: Multiple Chronic Conditions
The program’s development took twenty-six months and an investment of nearly $500,000. Since CCTP ended in 2015, AIHS and other AAAs have been leveraging the experience gained in working with hospitals to design new business opportunities with healthcare organi- zations—for care transitions interventions, com- plex case management, care coordination, and more. Technical assistance for AAAs to master new skills and protocols that these partnerships require has led to a public−private “business acu- men” initiative, headed jointly by the Adminis- tration for Community Living and the National Association of Area Agencies on Aging (n4a). In 2016, n4a established a new center for this pur- pose, the Aging and Disability Business Institute (tinyurl.com/y7hh8mwk). In August 2018, AIHS launched a Managed Services Organization (MSO) for AAAs and other community-based organizations (CBO), called Preferred Community Health Partners (PCHP). Community-Based Providers in Large Contracts with Managed Care Plans In Fort Wayne, Indiana, Aging & In-Home Ser- vices (AIHS) of Northeastern Indiana, a leading AAA, is partnering with Preferred Population Health Management. AIHS has embraced a wide-angle vision of how the aging network can align its mission in the context of large-scale managed care delivery systems. Like other AAAs, AIHS gained valuable experience in working with high-risk patients within hospital settings during a pioneering five-year demon- stration—the Community-based Care Transi- tions Program (CCTP) ( Journal of Healthcare Contracting , 2017). services arrangement. The MA plan and PACE organization also would establish an integrated care-planning team, and have shared access to interoperable records.
Figure 3. Model 2: MA Plan and PACE Both Provide Services
In Model Number 2, the MA plan and PACE organization both provide services, and the MA plan pays the PACE organization to provide a specific set of Medicare-covered services and supplemental benefits under contract. In this arrangement, some Medicare-covered services and supplemental benefits remain the respon- sibility of the MA plan, and some would be pro- vided by the PACE organization. Supportive services that are not supplemental benefits in the MA plan would be the responsibility of the PACE organization, and their costs would be paid by the beneficiary, by a charity, by Medicaid, or by another public program. Model Number 2 would most clearly fit a staff model MA plan that succeeds in provid- ing customized care for Medicare beneficia- ries living with advanced chronic illness. MA plan enrollees with chronic conditions would have the advantages of access to LTSS services at a PACE Center—services such as nutrition support, socialization, personal care and assis- tance, along with transportation, caregiver sup- port, and extensive coordination of services and supports; parties would negotiate and con- tract for a shared financial and a shared clinical
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