Dear Mr. President:
As boomers turn age 60, mey increasingly need long-term supports and services, especially for their elderly parents. In seeking those services, they face a complex and fragmented health and long-term care service delivery system. This loosely jointed system is beleaguered by poor communication and coordination among providers and payers, along with little, if any, integration of acute healthcare services, long-term care and social support programs.
Management of chronic conditions in older people is one of the most important concerns for state and federal policymakers. The Institute of Medicine has suggested mat the integration of care delivery, evidence-based medicine and chronic- care disease management could play a significant role in improving care quality and reducing costs for this population. A critical strategy is to align financial incentives properly to encourage the coordination of care, because physicians are currendy paid only for face-to-face episodic care, not for the continuous, between- visit care that can manage multiple chronic conditions effectively.
Care coordination in state and federal programs for older adulte and people with disabilities has resulted in a variety of positive outcomes for program beneficiaries and tiieir informal caregivers. For example, care coordination has been associated with improved functional status, decreased hospital admissions and fewer nursing home stays for elders; increased physician productivity; and reduced unmet needs and reduced stress among family caregivers. Only recendy has the importance of integrating care coordination across the range of services and systems been recognized for its ability to lower barriers between psychosocial support, medical care, preventive health measures and long-term care.
Less than one-quarter of Medicare beneficiaries account for almost three-quarters of total Medicare spending. …