Preventing Chronic Disease: The New Public Health

There is a national epidemic of chronic disease. Though it does not get the news coverage devoted to floods and tornadoes, it deserves attention and is starting to get it. There is a groundswell of activity in local communities to support healthier lifestyles and help people make long-lasting and sustainable changes that can reduce their risk for chronic diseases. A number of provisions in the health reform law are aimed directly at improving population health by addressing conditions where Americans live, learn, work, and play – at their schools, worksites, restaurants and more.

More Than Meets the Eye: Long-Term Care Provisions in the New Reform Law

Most of the emphasis during the health reform debate centered on affordable health coverage for the uninsured, strategies to control the growth in health care spending, and delivery system reforms. Relatively little attention was given to the many provisions of the new law that deal directly with long-term care.

Long-Term Care: Exploring the Possibilities

Almost every day, we learn of a new hearing or briefing about ways to improve our health care system. The White House, Congress, advocates and stakeholders are fully engaged. The elephant in the room during those discussions is long-term care. Despite being so large, it suffers from the possibility of being ignored. This March 9 forum, supported by the SCAN Foundation, brought together opinion leaders and stakeholders to explore options for the future of long-term care in the reform debate. Participants considered key policy questions on how to move from testing models at the edges to implementing feasible options through health reform.

Primary Care Innovation: The Patient-Centered Medical Home

It is widely accepted that the U.S. health care system, although touted by some as the “best system in the world,” has room for improvement. Many people have no regular health care provider. Care is often fragmented and lacks coordination, which compromises quality and efficiency. Incentives for providers have not caught up with the demographics of chronic care. Some 75 percent of Medicare spending is on beneficiaries with five or more chronic conditions – and those people see an average of 14 different physicians a year.

Low-Income Adults: Can Medicaid Fill the Coverage Gap?

If you think that all poor Americans can get health coverage through Medicaid, think again. Except in a few states with federal waivers, adults must not only meet income and asset requirements, but must fit into a category of persons for which coverage is available.

Changing the Culture and Improving Quality: Innovations in Long-Term Care

Culture change in the long-term care world involves many players – residents, administrators, workers, lawmakers, policy analysts – sharing a common vision. One such vision attracting attention has been developed by a group of citizens, providers and advocates known as Pioneers who are exploring alternatives to traditional nursing facilities. Their goal: facilities that are resident-centered, less institutional and more home-like. This involves trying to piece together financing from Medicaid, Medicare and private funding sources.

Quality Care and Comfort at the End of Life: Changes Needed?

The American health system is focused on curing, and spends billions of dollars on treatment at the end of life. But now more than 40 million adult Americans suffer with life-altering, chronic health conditions. They and their families are often more concerned with pain management, comfort care, and coordinating care as they transition from setting to setting. As people live longer with grave chronic illness are they getting quality care? Where in the delivery of care spectrum should palliative care come into play? Sponsored by the Alliance and the Robert Wood Johnson Foundation.

Treatment of Severe Chronic Illness: What Explains Cost and Quality Variations? Should We Be Concerned?

Some Medicare beneficiaries receive significantly more hospital-based services during the last two years of life than do other beneficiaries. The number of physician visits for Medicare beneficiaries can also vary greatly. What accounts for this variation? Do patients receiving more services tend to get better care, or not? Should policymakers take steps to more closely examine the relationship between spending and the volume of services provided at different facilities?

Caring For the Elderly: Is There Any Answer to Rising Health Costs?

The costs of caring for the elderly have been growing steadily higher. Spending on Medicare benefits accounted for 17 percent of the nation’s total health care spending in 2004. With baby boomers retiring, and Medicare benefits changing, this percentage is expected to grow in the future. Americans spend approximately $140 billion on long-term care in the U.S., most of it on the elderly, and Medicaid picks up almost half of the cost. Even among large private firms, health care costs for older people have taken their toll with only one-third offering health benefits to their retirees today, compared with two-thirds in 1988.

Cash and Counseling: Part of the Long-Term Care Answer?

“Cash and Counseling” is a way of allowing individuals receiving personal assistance services through Medicaid to have more control over the services they get and who provides them. The program provides an individualized allowance that beneficiaries can use to hire a personal care assistant of their choice – often a family caregiver – or purchase items that help them live independently, such as chair lifts.

Examining Medicare’s Two-Year Waiting Period for Individuals with Disabilities

In addition to providing health insurance coverage for 35 million seniors, Medicare covers about 6 million disabled beneficiaries under age 65 who are entitled to cash benefits under the Social Security Disability Insurance (SSDI) program. SSDI is designed to assist adults who are unable to work due to severe, long-lasting disabilities. However, disabled people who wish to receive coverage under Medicare must first qualify for SSDI cash benefits and wait five months before receiving the benefit. These individuals must then wait an additional two years before becoming eligible for Medicare.

Nursing Home Quality: Better Care Through Better Staffing?

In November 2002, the Centers for Medicare and Medicaid Services (CMS) launched a nationwide initiative to improve nursing home quality by making information about the quality of care in individual nursing homes much more widely available. This was a welcome step toward giving consumers more information about the quality of nursing home care. Since a study by the Institute of Medicine more than 15 years ago found serious and widespread deficiencies in nursing home care, several major studies have confirmed continuing difficulties.