A New York State demonstration program offering managed care to low-income adults who require long-term care appears to be enrolling more patients than previous programs, according to the initial findings of an Urban Institute study. At the same time, the program offers an expanded range of services. If the early success of the initiative, the Evaluated Medicaid Long-Term Care Capitation Program, can be sustained, it may provide a model for other states seeking ways to coordinate care provided to these patients.
Study results are described in The Commonwealth Fund report, Coordinating Care for the Elderly: A Case Study of a Medicaid Long-Term Care Capitation Program in New York, by Korbin Liu and colleagues. The Fund provided start-up support for the demonstration program.
Many elderly or disabled low-income adults qualify for both Medicare and Medicaid benefits. States are currently pursuing one of two strategies to integrate long-term and acute care services provided to these patients, increase flexibility in delivering benefits, and improve incentives for the appropriate use of health care services. The first strategy combines Medicare and Medicaid payments into a single capitated payment and makes one plan responsible for providing all long-term and acute care services. The second strategy coordinates, rather than integrates, Medicare- and Medicaid-financed health care, with capitated payments for Medicaid services.
New York's demonstration program for dually eligible patients uses the coordinated care model. It differs from integrated acute and long-term care programs in that it capitates only long-term care payments. Also, the New York program is required to coordinate with Medicare acute care rather than fully integrating all patient care financing.
Capitated Medicaid long-term care also appears to be an improvement over standard public home and community-based care in New York, according to Liu. The participating plans' ability to offer extensive transportation services, normally uncovered social services, and case management is an expansion of the generous levels of care provided under the state's Medicaid program.
The plans discussed in the report are VNS Choice, a subsidiary of the Visiting Nurse Service of New York; Co-op Care, operated by a subacute skilled nursing facility in the Bronx; and Senior Network Health (SNH), part of an integrated acute care system in Oneida County.
Facts and Figures
- All three sites offer nontraditional services to reduce future hospital and nursing home costs-home improve-ments such as ramps and roll-in showers, and special medical equip-ment like bathtub seats and walkers.
- Within the first year, about 90 percent of VNS Choice enrollees came from internal VNS referrals; Co-op Care and SNH, lacking strong internal referral bases, relied on referrals from local departments of social services.
- Within the first year, about 90 percent of VNS Choice enrollees came from internal VNS referrals; Co-op Care and SNH, lacking strong internal referral bases, relied on referrals from local departments of social services.
