Insights from a pilot program to integrate medical and social services.

This study examines lessons learned from the design, implementation, and early results of an integrated managed care pilot program linking member benefits of a Medicare-Medicaid health care plan with community services and supports. The health plan's average monthly costs for members receiving an assessment and services declined by an economically meaningful, statistically significant amount in the postintervention period relative to the preintervention period compared with those who did not accept an assessment or services. The results along with the lesson learned from the pilot are viewed by the parties as supportive of further program development.

Care Coordination and the Expansion of Nursing Scopes of Practice.

Nurse practitioners can ease increased pressure on primary care shortage while providing a cost-effective and high-quality alternative to certain physician services. However, scope-of-practice laws are restrictive and their modification remains a source of controversy. Clearly, there is a need for new thinking around the scope of practice debate.

Partnership long-term care insurance: lessons for CLASS program development.

The Community Living Assistance Services and Supports (CLASS) Act was a voluntary public insurance strategy intended to help people pay for long-term care. CLASS was passed as part of health reform to overcome aspects of private long-term care insurance market failure but came under close scrutiny from both its supporters and its detractors. Experience with the long-term care insurance market and State Partnership Programs provide insights about how to make CLASS fiscally viable.

Partnership insurance: an innovation to meet long-term care financing needs in an era of federal minimalism.

In the case of long-term care financing, federal minimalism is not new news. Long-term care has long played a weak "third fiddle" to national health reform concerns about the uninsured and catastrophic expenditures on prescription drugs. The states have been left to struggle with the issue of long-term financing as part of their responsibilities in funding and administering the means-tested Medicaid program.

Cash and counseling and managed long-term care?

This article presents the results of a survey on the interest of managed care organizations (MCOs) in developing a "cash and counseling" (C&C) option for delivering long-term personal assistance services. Forty-five percent of the respondents expressed interest, at least for some clients. Although specific experience with consumer direction did not have an effect, three organizational factors--larger size, non-PACE, and not limited to the elderly--predicted MCOs' willingness to consider this option.

Consumer direction in managed long-term care: an exploratory survey of practices and perceptions.

Purpose: This article presents results of a survey of the attitudes and practices of managed care organizations (MCOs) concerning consumer direction. The study focused on understanding several alternative measures of consumer direction and the factors that are associated with the MCOs concerning those measures.

Design And Methods: The MCOs that were surveyed provided capitated managed long-term care benefits to their Medicaid-eligible clients and were chosen because personal assistance service is a likely area for consumer-direction interest or practice.