KEY COMPONENTS FOR SUCCESSFUL LTSS INTEGRATION
DEVELOPING THE BUSINESS CASE FOR LTSS INTEGRATION
A small share of the population with the most complex care needs accounts for a large portion of all healthcare spending. Healthcare payment and delivery innovation are providing incentives for health plans and other organizations assuming financial risk to target high-value interventions to reduce spending. However, many of the organizations that hold financial risk for an enrolled population lack the awareness and tools necessary to design and target fully integrated interventions to achieve cost and quality outcomes.
Widespread experience with integrated approaches and evidence of a return on investment in non-medical services is lacking. Hard evidence of the aggregate financial benefit to health plans, health systems and other program sponsors of providing LTSS in addition to medical and behavioral care is needed to encourage more organizations to invest in integrating LTSS.
We partnered with the Long-Term Care Quality Alliance (LTQA) to define the intervention of LTSS integration—what integration is and how it works. For our study, we selected five organizations around the country that have experience integrating LTSS and medical care and are held to be successful examples of LTSS integration:
- ArchCare (New York);
- Health Plan of San Mateo (California);
- Superior STAR+PLUS (Texas);
- United Healthcare ALTCS (Arizona); and
- UnitedHealthcare SCO (Massachusetts).
We found that a program’s success in integrating medical care, behavioral healthcare, and LTSS and implementing an effective care model is a function of a number of factors, some of which are external to the organization and some of which come from the organization’s own history, structure, and culture. Factors that influenced the variation in how the programs integrated LTSS and the challenges they faced included state Medicaid requirements, culture of the partner organization, type of health plan, and population covered.
The programs we studied employed generally similar care models for members with LTSS needs; however, the care models varied in the extent to which they applied a uniform care model across their entire LTSS population or varied it according to the member’s level of need. They also varied in the extent to which they engaged the medical providers and shared or pooled information with the medical team. We also analyzed each program’s successes and challenges in aligning provider and program incentives and engaging providers effectively in care management and coordination.
In observing and comparing the programs, we identified several activities that affect outcomes for members and overall costs of care.
We found many ways in which programs that take risk for and integrate LTSS and medical care influence the utilization of LTSS and medical services to both manage LTSS spending and to avoid and reduce medical care expenditures for those members at highest risk for health care spending. It is reasonable to assume there would be substantial health care savings resulting from an intensive approach to a particularly expensive subset of the population.
LTQA’s next step is to explore the potential to develop empirical evidence of savings and quality outcomes attributable to integrated LTSS. This study and the Taxonomy provide the framework for measuring the impact of integrated LTSS.