A Primer on Managed Care: Multiple Chronic Conditions
and lessons learned from the Dementia CMC Project will be relevant to these models. California’s efforts to improve dementia care in the duals demonstration are currently being replicated with ACL’s support in the State of Texas. And following California’s lead, the State of Rhode Island’s duals demonstration also man- dates the training of dementia care specialists. Additionally, the opportunity to access publicly funded HCBS may soon be expanded in a limited way to beneficiaries with Medicare alone. The recently passed CHRONIC Care Act expands Medicare Advantage supplemental ben- efits to non-medical services and includes flex- ibility to offer some types of HCBS, such as adult day services or evidence-based caregiver edu- cation that could help plans avoid the costs of unnecessary hospitalizations or institutionaliza- tions. However, because Medicare Advantage ‘We didn’t have a good grasp on how many of our members potentially had dementia.’ plans are only required to support ninety days of long-term care, it is uncertain whether the desire to avoid such costs will be strong enough to incentivize the use of these new HCBS bene- fit options. Reforms such as CMC provided extra financial incentives to plans by making them responsible for the full extent of HCBS, LTSS, and long-term care. Given the growing population of low-income older adults with complex care needs, a managed care approach with well-trained care manag- ers and robust partnerships with CBOs can help support people in the community setting. The potential cost-savings resulting from providing dementia-capable care coordination are likely to make these models attractive to federal and
state payers and policy makers for the foresee- able future.
Brooke Hollister, Ph.D., is an associate professor in the Institute for Health & Aging at the University of California, San Francisco (UCSF), and in the Center for Care Research at the University of Agder, Norway. She can be contacted at Brooke.Hollister@ucsf.edu. Jarmin Yeh is a doctoral candidate in the Social and Behavioral Sciences Department at UCSF and a graduate student researcher in the Institute for Health & Aging. Leslie Ross, Ph.D., is a research specialist in the Institute for Health & Aging and in the Social and Behavioral Sciences Department at UCSF. Jennifer Schlesinger, M.P.H., is director of Professional Training and Healthcare Services at Alzheimer’s Los Angeles. Debra Cherry, Ph.D., is executive vice president of Alzheimer’s Los Angeles and voluntary clinical faculty at University of California, Los Angeles. Authors’ Note This project was supported, in part, by grant numbers 90DS2002-01-00 and 90DS2017-01-00, from the Administration on Aging, U.S. Admin- istration for Community Living (ACL), U.S. Department of Health and Human Services, the California Department of Aging, and the Change AGEnts Initiative Dementia Caregiving Network, funded by The John A. Hartford Foundation through a multi-year grant to The Gerontological Society of America. Additional funding was pro- vided by the Allergan Foundation, the Rosalinde and Arthur Gilbert Foundation, the Ralph M. Parsons Foundation, and the Harry and Jean- nette Weinberg Foundation. Grantees undertak- ing projects under government or foundation sponsorship are encouraged to express freely their findings and conclusions. Grantees’ points of view or opinions do not, therefore, necessarily represent those of ACL, the California Depart- ment of Aging, or any other of the project funders.
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