The Way Forward: 2010 Area Agency on Aging Annual Report
For over 35 years, Ohio’s Area Agencies on Aging have provided services to promote independence for older adults. While Ohio’s $8 billion budgetary challenges are unprecedented, there remains opportunity because we offer the public policy solution to Ohio’s Medicaid long term care problem: “consumer choice.” In rare circumstances will consumers so consistently opt for the least expensive option. But in long term care, home is where the heart is, and a consumer-driven home and community based care system holds the key to saving Ohio taxpayers $billions. According to the Ohio Business Roundtable, if Ohio’s annualized Medicaid spending per member moved to the national average, the State would realize nearly $1 billion in savings a year. Additionally, if Ohio moved to the first quartile of states, Ohio’s savings would be $2 billion annually.
The Changing Face of Medicare
A primary thrust of Medicare Reform targets the dual eligibles, those who receive both Medicare and Medicaid. According to a 2010 study by AARP, 8.1 million dual eligibles represent disproportionate spending in both programs. They make up 18 percent of the Medicaid population but represent 46 percent of Medicaid expenditures. In Medicare, they comprise 16 percent of the population but account for 27 percent of all expenditures. Specifically, Medicare reform is aimed at reducing avoidable hospital readmissions around 5 chronic diseases. These include Heart Disease, Stroke, Diabetes, Cancer, and Chronic Obstructive Pulmonary Disease (COPD). Medicare’s focus on dual eligibles with these chronic diseases is particularly relevant to us, as 85% of our PASSPORT and Assisted Living members are dual eligibles and nearly all (92%) have one or more of these infirmities.The Changing Face of Medicaid
There have been three Medicaid Reform Commissions appointed by Ohio’s last two Governors, dating back to 2003. While there has been much discussion, there has been limited action. But it is clear that Medicaid reform in Ohio needs to begin first by making long term care (as opposed to simply nursing home) the entitlement in any venue, thus promoting consumer choice in care settings. This can be accomplished by utilizing AAA’s Aging and Disability Resource Centers to create the front door to long term care and the primary vehicle for nursing home diversion. Second, the existing nursing home population should be care managed by Area Agencies on Aging in order to expedite transition to more appropriate, less expensive, and more desirable care settings. Third, the Medicaid nursing home bed supply needs to be “right-sized.” Limiting bed supply will immediately eliminate the “need” to backfill beds with other populations. Fourth, we need to expand options in the middle of the care continuum to include Foster Care Facilities for consumers unable to live at home but that do not require permanent nursing home placement. Finally, we need to better integrate Medicare services with long term care. This could be accomplished by quickly implementing the following recommendations from the Unified Long Term Care System Workgroup Report of 2010:- Allow Medicaid Managed Care beneficiaries the choice to maintain their benefits when they enroll in PASSPORT or Assisted Living.
- Expand access to information, assistance/referral and Long-term Care Consultations through AAA’s Aging and Disability Resource Centers.
- Deploy Area Agency on Aging Long-term Care Registered Nurse Consultants in hospitals, to transition patients to home and community based care settings.
- Develop Area Agency on Aging/health care partnerships and train to implement evidence-based health coaching programs.
- Deploy Area Agency on Aging Long-term Care Registered Nurse Consultants in large Medicaid physician practices and patient-centered medical homes to support patient access to available community-based programs.
Implementing these simple changes to the long term care system will address the three key public policy issues confronting Ohio’s Medicaid long term care system: defining consumer choice in long term care, building the middle of the care setting continuum, and integrating medical and long term care services. Moving aggressively, we will improve consumer outcomes and satisfaction and according to the Ohio Business Roundtable save Ohio taxpayers up to $2 billion each year. The State cannot continue to ignore savings of that magnitude, and to facilitate this change in our region, we have developed The Way Forward. Our FY11-14 Strategic Vision is structured into five cornerstones:
Our Consumer Plan: Make Consumer Choice a Reality in Long-term Care
Our Advocacy Plan: Fight to Win
Our People Plan: Work Together
Our Quality Plan: Build it Better
Our Financial Plan: Invest in the Future
The preceding discussion serves to focus and guide us as we implement The Way Forward. The inescapable context and driving force of this discussion is the fact that we face a current and future environment that presents conflicting realities: increased demand and constrained resources (a growing older adult population constrained by dire economic realities). We have positioned ourselves to address this seemingly irreconcilable conflict in a manner that provides care for indigent, frail older adults in Ohio, as well as providing the economic solution to Ohio’s Medicaid long term care problem.
Joseph L. Ruby President & CEO
