Here’s a new concept for Medicare Advantage insurance: integrating its use as part of a long-term care system with basic benefits to help the patient avoid long stays in the hospital. Essentially, the foundation of this concept is based on the idea that prevention is the key to keeping health care costs down. Howard Gleckman presents this interesting approach to Medicare Reform in his article for Forbes.com.
A New Concept for Medicare Advantage Insurance
Why not make insurance for long-term care services and supports part of health care coverage?
It is a radical idea that turns the current model—which often treats long-term care insurance as an element of retirement planning—entirely on its head.
The concept isn’t new. John Rother, who ran public policy for AARP for many years, talked about integrating long-term services and chronic care long ago. And real people with chronic disease see no difference between medical and personal care. But nobody could ever figure out how to make the insurance work.
Here’s the problem: As long as most medical insurance was based on a fee-for-service model, there was little incentive for carriers to provide benefits for personal care. Why would they add a costly extra benefit if it didn’t improve the bottom line?
But the rise of Medicare Advantage managed care plans, Medicaid managed care, and the growth of integrated health systems such as Kaiser Permanente may be changing that. In fact, a few states are effectively trying this experiment by expanding Medicaid managed care to seniors. The PACE program is built on the same idea.
In all these managed care models, which are explicitly encouraged by the 2010 health reform law, insurers are at financial risk if their cost of care is too high. And they have the opportunity to make more money if they can provide quality care at lower cost. Original Story Here.
This new concept for Medicare Advantage Insurance is truly not a bad idea. At this point, the current system is failing and health care costs are continuing to rise. We have an obligation (moral and otherwise) to do our best to insure its success.