putting the consumer first: consumer direction in long-term care

The Hilltop Institute was formerly the Center for Health Program Development and Management.

Putting the Consumer First:Consumer Direction in Long-Term Care

March 31, 2009

Chuck Milligan

Innovation in Health Policy Series

DC Department of Health Care Finance

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Overview

Portrait of Long-Term Care

Consumer Direction

Two Examples from Mi Via (from DVD)

Needed Functions and Competencies

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Portrait of Long-Term Care

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Medicaid and Medicare are the major third-party payers for long-term care, and out-of-pocket is high.

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Expenditures in Medicaid long-term care continue to grow, especially for community-based services.

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Medicaid is the largest payer for nursing home care.

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36 percent of Medicaid expenditures, or about $109 billion, goes toward long-term care . . .

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DC utilizes institutional services at a higher-than-average rate.

United States

58.3%

41.7%

Source: Thomson Reuters

DC ranks 40th

out of 51

DC

67.4%

32.6%

% Community-Based

% Institution-Based

Distribution of Medicaid LTC Dollars, FY 2007

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Consumer Direction

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Aspects of Consumer Direction More flexibility in benefit design

Still subject to some level of approval/oversight Agency must balance: serving beneficiaries and serving

taxpayers

More control of benefit choices and use Have sufficient independence from provider? Overuse? Underuse?

More control of prices Have sufficient “market power”? Have sufficient independence from provider?

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Two Examples from Mi Via (from DVD)

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Needed Functions and Competencies

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Functions and Competencies Financial management

Review purchases Connect to plans of care Receive and process invoices, connected to plans of care Protect against fraud & abuse by provider and/or beneficiary

Counseling Assist beneficiaries in developing budgets and making decisions Assist beneficiaries in hiring, firing, training, & scheduling workers

Market role Monitor prices and supplier behavior

Determine credentialing standards for paid providers

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Contact Information

Charles Milligan

Executive Director

The Hilltop Institute

University of Maryland, Baltimore County (UMBC)

410.455.6274

cmilligan@hilltop.umbc.edu

www.hilltopinstitute.org