May 1, 2019
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.
The Long-Term Quality Alliance (LTQA), 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, conducted a study comparing rates of medical utilization for members age 65 and older who need LTSS enrolled in plans integrating LTSS and medical care with rates for similar individuals in traditional (fee-for-service) Medicare. 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).
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.
The full Report and Technical Appendix are available below.
This Study was made possible through a grant from the Laura and John Arnold Foundation.