A Primer on Managed Care: Multiple Chronic Conditions

munities they are committed to serving over the long term.

for disabilities, which generally decrease medi- cal care costs over time (Montgomery, 2018). These and other types of innovative arrange- ments will be tested as LTSS assume a more prominent role in healthcare delivery. To address rising demand in the frail elderly popu- lation, service capacity for LTSS will need to be steadily expanded in communities across the country. In turn, this may lead to collaborations between MCOs and LTSS providers that delib- erately set out to capture savings from avoided high-cost care (primarily inpatient hospitaliza- tion), and which can be used to buttress local service capacity. Anne Montgomery is deputy director of the Altarum’s Program to Improve Eldercare in Washington, D.C. Sarah Slocum is a health policy analyst at Altarum’s Program to Improve Eldercare in Ann Arbor, Michigan.

Conclusion Contracts and partnerships that AAAs and CBOs are forming with MCOs are becoming more streamlined and organized, a trend that benefits community-based care. Similarly, PACE plans are well-positioned to begin outlining the parameters of arrangements with MA plans to improve the cost-effectiveness, quality, and reliability of services for frail older adults. To maximally benefit communities, contracts could consider specifying that a portion of savings realized from avoided high-cost care (i.e., inpa- tient hospitalization) be invested in community- based supportive service capacity−building, such as workforce recruitment and training, employer support of caregivers, and housing adaptations

References Bipartisan Budget Act. 2018. H.R. 1892. 115 th Cong. Centers for Medicare & Medi­ caid (CMS). 2018a. Reinterpreta- tion of “Primarily Health Related” for Supplemental Benefits . tinyurl. com/ybcx7o5w. Retrieved October 2, 2018. CMS. 2018b. Announcement of Cal- endar Year (CY) Medicare Advan- tage Capitation Rates and Medicare Advantage and Part D Payment Pol- icies and Final Call Letter. tinyurl. com/y7jqdxsu. Retrieved Novem- ber 9, 2018. Holly, R. 2018. “Anthem Adds Home Care Benefits Under Relaxed Medicare Advantage Rule.” Retrieved October 25, 2018.

Norman, J. 2013. “The Aging Pop- ulation: A Crisis in Plain Sight.” Retrieved October 2, 2018. Open Minds. 2018. “2018 Long- Term Services & Support Market Update.” Retrieved October 2, 2018. Super, N., Kaschak, M., and Blair, E., 2018. “Health Care and Com- munity-based Organizations Have Finally Begun Partnering to Inte- grate Health and Long-Term Care.” Health Affairs Blog. tinyurl. com/ycnlphbe. Retrieved October 2, 2018.

Journal of Healthcare Contracting . 2017. “Care Transitions Programs Meet Discharged Patients in the Home, to Prevent Readmissions and Hasten a Return to Health.” Retrieved October 15, 2018. Lewis, E., et al. 2017. “The Growth of Managed Long-Term Services and Supports Programs: 2017 Update.” Retrieved November 9, 2018. Montgomery, A. 2018. “Financial Forecasting for MediCaring Com- munities.” . Retrieved November 8, 2018.

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