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Managed care and long-term care: a potential solution?

Pamela Nadash, Joann Ahrens

    Policy Brief (Center for Home Care Policy and Research (U.S.))
    |March 31, 2005
    PubMed
    Summary
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    Managed care offers solutions for long-term care needs, but challenges exist. Research shows provider-sponsored plans can improve efficiency and client satisfaction through capitation, though nursing home admission rates remain unaffected.

    Area of Science:

    • Health Services Research
    • Public Health Policy

    Background:

    • Managed care is proposed to address complex health needs of long-term care populations.
    • Previous research highlights challenges in implementing managed care for this demographic.

    Purpose of the Study:

    • To examine reasons for commercial managed care plan failures in long-term care.
    • To evaluate the impact of managed care adoption by a provider-sponsored organization.

    Main Methods:

    • Review of research on state attempts to engage commercial managed care plans.
    • Evaluation of a provider-sponsored organization transitioning to managed care.

    Main Results:

    • Commercial plans faced barriers to participating in long-term care.

    Related Experiment Videos

  • Provider-sponsored plans encountered organizational challenges, leading to increased efficiency.
  • Capitation reimbursement improved plan finances and service range, maintaining client satisfaction.
  • Capitation did not significantly alter nursing home admission rates.

    • Conclusions:

    • Lessons from commercial plan failures can inform provider-sponsored long-term care initiatives.
    • Managed care, particularly with capitation, can enhance service delivery and efficiency for long-term care populations.
    • Further research is needed on optimizing managed care for long-term care to impact all outcomes, including nursing home use.