ManagedCareSupplement3

GENERATIONS – Journal of the American Society on Aging

In 2018, The Bipartisan Budget Act was signed into law, which incorporated the Creat- ing High-Quality Results and Outcomes Neces­ sary to Improve Care (CHRONIC) Care Act (2017). The new law significantly advances pol- icies related to providing integrated, person- centered care for Medicare beneficiaries and for those who are dually eligible for Medicare and Medicaid. The Act provides an opportunity for Medicare Advantage to provide supplemental Heart disease, cancer, stroke, COPD, and diabetes account for 75 percent of healthcare spending. benefits to cover the costs of some non-medi- cal needs for high-need, high-cost beneficiaries. This also applies to those in permanently autho- rized Special Needs Plans (D-SNP; for dual eli- gibles), Chronic Condition Special Needs Plans (C-SNP; for people with chronic disabling condi- tions), Institutional Special Needs Plans (I-SNP; for institutionalized individuals), and provides greater flexibility to ACOs. A focus on population health management With these opportunities, the healthcare sector has focused on population health management and social determinants of health. Population health management typically uses data to iden- tify at-risk individuals and apply interventions to manage their health needs; and the healthcare sector employs diagnosis and claims data to tar- get the highest utilizers. These are retrospective data, which means the healthcare sector begins the intervention after a person already has used healthcare services. For some providers, this means that the individual’s needs are harder to address and support. There has been much dis- cussion and early work to predict which patients might be future high utilizers, in order to antici- pate needs and deploy an intervention before healthcare utilization begins (Figueroa et al., 2017; Joynt et al., 2017). Healthcare entities are

still working out how to do this in a meaningful and cost-effective way. Diagnosis and claims data provide only one picture of an older adult’s health. Functional status is another major indicator of healthcare services use. Assessing an individual’s func- tional status and acting upon that information is an effective strategy for identifying people who are high-risk and high-cost. Those provid- ers participating in the Financial Alignment Initiative are required to conduct health risk assessments of their members. These assess- ments take into account all aspects of indivi­ duals’ medical, biological, and psychosocial needs. To this end, the California Department of Health Care Services, in 2018, required plans to add ten questions specific to function to the health risk assessment (The SCAN Founda- tion, 2018). Additionally, in the 2019 Call Letter (CMS, 2018c), CMS recognized the importance of why a health risk assessment should include a functional assessment. Healthcare Environment Continues to Evolve The shift from volume to outcomes in health- care continues to grow. There are several partnerships that have moved from pilots to ongoing sustainable collaborations for both parties. These early adopters have seen the benefits in improved quality of life for older adults but also in savings. Savings and ben- efits result from delaying institutionalization, reducing readmissions to hospitals, shortening hospital lengths of stay, and reducing emer- gency department visits. CBOs have made these benefits and savings possible through providing short-term and ongoing care management and care transitions, providing nutrition and trans- portation services, and linking older adults to other programs that offer housing, energy ‘The shift from volume to outcomes in healthcare continues to grow.’

6 | Spring 2019

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