FOR IMMEDIATE RELEASE
April 30, 2019
Contact: Mary Kaschak
Long-Term Quality Alliance
LTQA Releases Study on Medical Utilization in Health Plans that Integrate Long-Term Services and Supports (LTSS)
The Long-Term Quality Alliance (LTQA) today released the Final Report from a study on “Medical Utilization in Plans that Integrate Long-Term Services and Supports.” The study was completed with assistance from researchers at the Lipitz Center for Integrated Care at Johns Hopkins University and with support from the Laura and John Arnold Foundation.
In recent years, policymakers have focused on the small population with the most complex care needs that account for more than half of health spending, and on interventions that can address functional needs and social determinants of health. This study provides new evidence of the potential for health plans that provide high-need beneficiaries with non-medical supports and services (including LTSS) to reduce avoidable and expensive hospital and institutional utilization.
For the study, LTQA engaged five organizations that serve members eligible for both Medicare and Medicaid benefits (“dual eligible” beneficiaries) and that combine coverage from the two programs to integrate medical and long-term services and supports (LTSS). For each plan, the study compared actual rates of emergency room (ER) visits, hospitalizations, and skilled nursing admissions for its members with multiple chronic conditions and functional limitations to rates predicted from Medicare FFS data for a similar population.
The LTQA project team found that the integrated plans had lower medical utilization rates for enrollees with functional limitations than were predicted for a similar population in traditional Medicare. The plans represented three different models for integrating this coverage and plan results varied across these integrated plan models. Each of the plans had some rates that were lower, while no plan had lower rates for all three measures.
Details of the study can be found in the Final Report at http://www.ltqa.org/report-integrated-utilization/.
The Long-Term Quality Alliance (LTQA) is a community of stakeholder organizations, including health care and social service providers, consumer advocates, and payers, that have come together to improve outcomes and quality of life for persons and families in need of long-term services and supports (LTSS). LTQA convenes and facilitates collaborative efforts to advance integrated LTSS and conducts research, education, and advocacy that contribute to the advancement of integrated approaches.