Long-Term Quality Alliance (LTQA) is a community of organizations aimed at improving outcomes and quality of life for persons who are managing functional limitations due to chronic health conditions, and their families.  It draws member organizations from the full range of health care and social services delivery systems involved in provision, administration, innovation, policymaking, and advocacy for quality long-term services and supports (LTSS).

Organizations come together in the Alliance to share knowledge and experience needed to advance development and continuous improvement of high-quality systems of integrated, person- and family-centered LTSS.  The Alliance serves as a convener of disparate private-sector and governmental organizations, with an eye to identifying and resolving the most significant challenges and advancing the replication of successful models that demonstrate the potential for more widespread adoption of person-centered LTSS integration.


The movement toward integration of medical care, behavioral health, and LTSS, centered on the person and family, offers a framework for making significant gains on long-standing problems with access to home and community-based LTSS, post-acute care transitions and readmissions, coordination of medical care and social services and supports, quality of community-based services, and LTSS financing.  The potential for slowing health care cost growth rests on developing more effective ways to manage care and improve the health of the population with high healthcare needs and costs.

Successful early intervention, targeted on the basis of functional limitations rather than health care needs, can be most effective at lowering costs and improving outcomes.  Managing a system of coordinated medical care and social services based on an individual’s own goals and preferences can reduce the need for expensive medical care, lower overall care costs, and improve outcomes.

To make the investment in social services and supports viable financially, however, the added costs of services have to be paired with the reduction in health care spending.  Full integration of medical and non-medical services funded by a single capitated premium provides both the incentive and the tools to achieve substantial savings and improve quality of life for high-cost, high-need individuals.

The reality of LTSS integration is a long way from the vision of a fully-integrated future.  There are relatively few successful models of full integration available today and few of the models that are successful have the capacity to scale up sufficiently to become a norm for how care is financed and delivered.

Before any of the service delivery improvement and financing solutions dependent on LTSS integration can take place, integration itself needs to become a widespread reality.  LTQA’s vision of the path to this future starts with projects that help build the foundation for LTSS integration, help scale up small successful models of LTSS integration, encourage large, well-resourced organizations to pursue LTSS integration on a large scale, and generally accelerate the pace of change toward widespread, LTSS integration.


The Long-Term Quality Alliance (LTQA) was launched in 2010, and operated in its early years as part of and with support from LeadingAge.

The Alliance was originally conceived as a vehicle to advance recommendations to improve long-term care quality reported from the National Commission for Quality Long-Term Care.  The Alliance participated initially, along with three other sector-specific quality alliances, in the Quality Alliance Steering Committee, chaired by Dr. Mark McClellan at the Brookings Institution.

In its early years, LTQA focused on identifying and promoting best practices in care coordination and care transitions that improved access and quality of care, and on developing collaboration within and among communities working on these issues. Its Innovative Communities Initiative (ICI) convened three ICI summits over its duration.  LTQA also convened a series of Annual Meetings, beginning in 2011, focused on care transitions, care coordination, and integration.

In 2013, the Alliance was incorporated as an independent, non-profit, tax-exempt organization and in 2014 moved to its own offices.  LTQA broadened its Board and Advisory Steering Committee to engage a wider array of stakeholders in its work.  Following on service delivery reform recommendations from the 2013 Report of the federal Commission on Long-Term Care, LTQA adopted a 5-year strategic plan intensifying its focus on advancing LTSS integration, service delivery reform, and quality.

Today, the Alliance is aimed at advancing high-quality, person- and family-centered, integrated long-term services and supports through projects involving research, analysis and policy, and advocacy.


LTQA has defined a five-year plan of activities to identify effective models of LTSS integration, build the business case, catalyze consensus, and mount a national campaign for financing LTSS integration.  LTQA’s focus over the next five years (2015 through 2019) will be on:

  • Developing the information needed to justify investments in integrated LTSS systems – especially investments by established health systems (ACOs) and health care plans;
  • Helping identify and remove impediments to developing and operating successful organizations and plans that integrate person-centered, high quality, LTSS and acute care;
  • Raising visibility and broadening support for LTSS integration, particularly as a platform for high quality, person-centered care, and for financing a major component of long-term care for persons of all ages with functional limitations;
  • Developing and gaining broad commitment to a vision for delivering and financing LTSS in the future and a clear path forward around which a wide array of stakeholder groups can coalesce.

LTQA will pursue a specific year-by-year plan to attain and implement a shared vision and path forward.  The plan will lead to a National Summit in the third year to obtain broad commitment to the vision and path forward, and follow-on implementation activities in the fourth and fifth year to advance successful LTSS integration.  The five-year LTQA plan includes:

Year 1:  Developing the Business Case for Integrated LTSS (2015)

LTQA intends to conduct a study of health systems and plans that currently integrate LTSS to measure the net effect on health care and related costs and on quality of life and health outcomes.  It will extensively promote the learnings from the study through a variety of media leading up to a workshop at the LeadingAge Annual Meeting in October 2015.

Year 2:  Laying the Foundation for The National Summit on Integrated LTSS  (2016)

LTQA will initiate work to identify impediments to and necessary preconditions for LTSS integration, with the intent of developing consensus across stakeholder groups on detailed work plans to remove impediments and lay the necessary foundation for successful LTSS integration on a large scale.

Year 3:  The National Summit on Integrated LTSS (Invitational) (2017)

In the third year, LTQA will focus on preparation for, execution of, and documentation of a National Summit of invited leaders from key sectors on policy related to LTSS integration.  LTQA will also focus on initial work to develop a plan for financing LTSS based on widespread availability of systems and health plans with integrated LTSS.

 Year 4:  Implementation and Advocacy (2018)

LTQA plans to shift its focus in the fourth year to implementation of the path forward articulated and committed to in the National Summit.   It will also work on finalizing and unveiling a related plan for financing long-term care, and launching a national campaign to promote adoption of LTSS integration and enactment of an LTSS financing solution.

Year 5:  Ongoing Implementation and Advocacy (2019)

In the fifth year, LTQA will continue and make sustainable the implementation of the path forward defined by the National Summit.   LTQA plans to maintain the working groups developed in the buildup to the Summit and will continue the Campaign initiated in the fourth year.