Integrate Services for People Needing

Integrate Services for People Needing Long-Term Care

Over the last several years, health care costs have been rising dramatically. Part of the reason why this is occurring, is due to the fact demand has increased. This has caused the underlying costs for different services to rise. Over the course of time, this is having a ripple effect on the industry and the amount that everyone is paying. Evidence of this can be seen within the insurance premiums that many businesses and individuals are paying. In a study that was conducted by the Common Wealth Fund, they found that businesses are seeing disbursements for health insurance premiums increase by 44% (between 2003 and 2009). While, individuals have seen a 77% increase in the costs that they are paying. (Schoen, 2010, pp. 1- 32) This is significant, because it is showing how skyrocketing health care prices are having an adverse impact on employers, workers and families.

As a result, the federal government has been working with the states to create a program that can deal with the various challenges in these areas. At the heart of this basic plan, is creating a test plan that will allow ten states to integrate various health care solutions under one program. The idea is to be able to address these issues by creating a state plan that can address all of the different needs of the public. Once this occurs, it is hoped that everyone will be able to receive better treatment options at lower costs. (Kasten, 2009)

Virginia is one of the ten states that are setting up a program to address all of these issues. To fully understand how the various aspects of how health care can be implemented into the state's plan requires: examining the current structure, how change can take place, the services offered / financing programs and how it can be implemented on the local levels. Together, these different elements will provide the greatest insights as to how an effective health care strategy can be employed by the State of Virginia. (Kasten, 2009)

The Current Structure for the State of Virginia

In 2006, Governor Kaine created the Health Reform Commission. Their objectives were: to gain a greater understanding of the health care system and make recommendation as to how it can be approved. One area that was of particular interest to the commission was integrating long-term care services as part of a total health care solution. This is because, the population was becoming older and many people wanted to see these kind programs implemented to address gaps in coverage for many Virginians. (Kasten, 2009) What they came up with was a series of the different recommendations for improving the kinds of services that were available to include:

To support and expand the options for long-term care services.

To ensure that consumer, caregivers and families have ample amounts of information about the kinds of services that were available. This would help them to more effectively plan for a wide variety of contingencies.

To improve state and local coordination for health care services.

To create more options for seniors and people with disabilities about the kinds of living facilities that they have available to them. (Kasten, 2009)

These recommendations are important, because they created a foundation of different strategies that could be used (to provide better health care solutions to all Virginians).

This lead to a change in focus on how various health care services were provided. To fully understand how this occurred requires examining the departments and programs that are run by the state. Once this takes place, it will provide specific insights about current structure and the changes.

Departments

There are a number of different departments within the state government that have a responsibility for regulating the health care industry. In general, they have similar powers that will often overlap with each other. This is designed to provide added amounts of regulation on the state level. Some of the most notable include: the oversight of senior citizens, adults with severe mental illness, individuals with physical / mental disabilities and children's disabilities. Each of the departments has a responsibility of regulating these areas in one way or another. The below list identifies each agency and roles that they play inside the industry. (Kasten, 2009)

Department of Medical Assistance Services -- this agency has many different responsibilities. To include: the regulation of financial services, approving / disapproving waivers, reviewing the activities of health care providers and coordinating out of state Medicare / Medicaid programs.

Department of Mental Health, Mental Retardation and Substance Abuse Services -- they have the authority to: regulate local Community Service Boards, licensing for mental health / substance abuse facilities and monitoring these areas for any kind of violations of state law.

Virginia Department for the Aging -- this department has the responsibility for: regulating area agencies on aging and helping patients who are transferring from a state psychiatric facility.

Department for Rehabilitative Services -- they have authority to: oversee employment / rehabilitative services and investigate Social Security Disability claims.

Department of Social Services -- they determine financial eligibility for Medicaid, auxiliary grants and other programs. At the same time they have other responsibilities including: monitoring assisted living facilities / foster homes and they provide adult / child protective services.

Virginia Department of Health -- they have the authority to monitor / license all Medicare certified nursing homes, hospices and home health agencies.

Virginia Office for Protection and Advocacy -- they protect the rights of people with disabilities through: training, investigation and legal representation.

Office of the Comprehensive Services Act -- they provide funding for: programs that are working with high risk youth with emotional and behavioral problems.

Governor's Office -- they are coordinating the integration of health care services through effective leadership.

Virginia Board for People with Disabilities -- they have the responsibility for regulating the Developmental Disabilities Planning Council. (Kasten, 2009)

These different elements are important because, they are showing how there are a wide variety of agencies that will monitor the health care industry. In some cases, these areas of responsibility could be overlapping (effectively providing dual regulation to select segments). (Kasten, 2009)

Long-Term Care Committees

At the same time, the state assembly has enacted the Community Advisory Commission in the Code of Virginia. This law requires that the state establishes committees that will monitor the progress of different government agencies on: how they are integrating people with disabilities in the community. The way this is accomplished is by having each of the local governments establish long-term care committees. They will consist of public officials and local citizens in the community. The basic idea with this approach is to increase the overall levels of accountability for the state government. This is significant, because it shows how Virginia is taking a proactive approach in trying to address their health care challenges. (Kasten, 2009)

How can Change take Place?

The main factor that has been driving integration is the rising demand that many consumers are placing on the health care system. This is because, the total number of people age 65 and older has been steadily increasing and this expected to continue over the next 70 years. Evidence of this can be seen with information that was compiled by the U.S. Census bureau. They found that within the state the total number of people age 65 and older accounted for just 12.9% of the population. In the year 2030, this number is projected to increase to 20.8% of the population. (Kasten, 2009)

Moreover, Lehning (2010) found that integration among health care service providers has become increasingly common over the last several decades. With her writing, "Three promising practices that have emerged in the past few decades include: the culture change movement; service integration that combines medical and social care; and various forms of community residential care that bring together housing and services in a more home-like environment." (Lehning, 2010, pp. 43 -- 63) This is significant, because it is illustrating why the state has been taking such a focus on addressing these issues. As, integration has become a tool that they can use to: keep up with rising demand and changing population demographics.

The Process for Coordinating Change

In order for any kind of integration plan to be effective means that everyone must agree: that change is necessary and there must be some kind of mutual benefit that can be realized for all of the stakeholders. As a result, this helped to fuel the push for these kinds of changes to take place. The reason why is because integration can provide a number of advantages including: you are using economies of scale to reduce costs, companies are gaining increased bargaining power, consumers have greater choices and costs are lower. (Pratt, 2010, pp. 223- 228) These different elements are important, because they are highlighting the underlying reasons for integration to occur.

To coordinate changes to the health care system requires, having people from all walks of life providing insights about: what elements should be included as part of the strategy. The way that this can be accomplished is by forming boards that are similar to Long-Term Care Committees. The only difference is that they would severe a similar role as a medical control board. Where, they will have the responsibility for determining how all of the different health care solutions should be integrated on the local level. In this case, these committees could follow the state's integration plans and then augment the various services that are being provided with a structure that will work well for each community. (Fisher, 2009, pp. 219 -- 231)

For example, the state could provide guidelines about how the different health care solutions need to be integrated together as one single plan. The way that this occurs on the local level, will determine the kinds of services that are offered by the various organizations. At the same time, it will depend upon how the community feels these kinds of solutions that need to be delivered. In this aspect, this kind of approach could involve the use of private health providers that are augmented with programs from: the municipal / county government and nonprofit organizations. This will give communities, the power to determine what kind of health care services should be provided and the way they are addressing these issues. The state will have the various Long-Term Care Committees monitor: the effectiveness of these services on the local level and if they are within state guidelines. (Fisher, 2009, pp. 219 -- 231)

If this kind of approach can be used, it will reduce the underlying issues that could affect integration (over areas of responsibility) by giving communities the power to create health care solutions that make sense for them. This will keep cost low and it will provide better services to Virginians. While, the increased usage of Long-Term Care Committees will help to ensure that there is proper oversight of these boards on the community and at the state levels. Over the course of time, this will help to reduce the underlying costs that are spent every year on health care services. This will have positive impact on the standard of living for many communities and it will make the state more attractive to businesses. This is because the plan has been able to effectively deal with health care costs and demand. These two factors will help many employers to carefully look at the state for the benefits that it can provide their businesses. (Fisher, 2009, pp. 219 -- 231)

This kind of approach has been used in Vermont to address rising health care costs. What makes our strategy so unique is that various peer reviewed publications, are supporting integrating health care services into to one system. Evidence of this can be seen with a study that was conducted by New England Journal of Medicine. They found that health care costs would decline under an integrated system, while the amounts of services would increase. Commenting about these findings researchers observed, "The Vermont single-payer plan will never be as efficient as Taiwan's or Canada's because it must work within the bounds of federal laws and programs and the realities of porous state borders. Nevertheless, it can produce substantial savings to fully fund universal coverage, reduce health care costs for most businesses and households over time, and reform a fragmented delivery system." (Hsiao, 2010, pp. 188 -- 1190) The below table is highlighting the saving that will be realized from these kinds of integration plans for the State of Vermont.

Impact of Integration Plans for the State of Vermont (in millions of dollars)

Category

2015

2016

2017

2018

2019

Savings

1,100

Costs

(Hsiao, 2010, pp. 188 -- 1190)

This is significant, because it shows how this kind of approach can address the challenges that are facing health care system of Virginia. The only difference is that greater control and transparency are being provided at the local level.

The Financing Programs and Services that should be Offered

The current system that is being used by the state is similar to the basic model that is utilized across the country. This involves the patient receiving different services through private and nonprofit health organizations. The government will play a limited role in the kinds of services and assistance that is being provided. As, any kind of assistance will depend upon the needs of each individual in the program. This means that plans such as Medicare and Medicaid will pay out a certain amount for health care expenses. The rest of these costs should be paid for by the individual and private insurance coverage that they are receiving. Over the course of time, this basic model has meant that costs for health care services have increasing. The reason why is there are gaps in coverage and many individuals are being forced to pay a larger amount of health care expenditures. This is having an impact on the kinds of services that are being utilized and the type of treatment options that are being provided. (Kasten, 2009)

To address these issues the strategy that is being utilized should provide a single solution for all Virginians. The way that this will be accomplished is the state can begin: requiring health care providers and insurance companies to bundle these different services together. This is in line with the various provisions of the Affordable Care Act (which is using this principal to help reduce costs nationally). (Cutler, 2010, pp. 1131 -- 1135)

At the same time, efficiency needs to be improved in these areas. One way that this could be accomplished is through integrating various technology solutions. As part of the tools that are being used such as: electronic medical records. Over the course of time, this will increase productivity and will provide better solutions for dealing with the various challenges facing the system. (Cutler, 2010, pp. 1131 -- 1135)

Over the short-term, this would cause health care costs to increase higher than the national average. The reason why is because, these kinds of changes will require upfront expenditures by the government and health care organizations. To achieve this objective, you must have a creative health solution that could be implemented. One possible strategy is to increase the excise taxes on: tobacco, alcohol and food items that could be contributing directly to obesity. Numerous studies have confirmed that these factors are the main causes that are contributing to raising health care costs. This is because various conditions related to lifestyle choices will require increased amounts of spending. If you are placing some kind of a sales tax on these items (such as $.02 cents), you are raising money to support these expenditures (within the portion of the population that is helping to fuel the increase). This kind of tax could be utilized on the state and local levels, with $.01 cent going towards each entity. In both the short- and long-term this would raise tremendous amounts of money that can be used to fund and improve the efficiency of the health care system. For example if over 300 million of items were sold over the course of two-month (i.e. someone purchasing a soda or a pack of cigarettes) this would generate $20 million in new revenues every two months. This could be used by the state and communities to help support upgrade of the health care system. (DeCicci, 2008, pp. 918 -- 929)

Utilizing this kind of strategy requires providing consistent financing by: taxing those products that are considered to always be in demand and having the people who are causing costs to increase the most (to pay more for the lifestyle choices they are making). At the same time, there will be an emphasis on the having many patients utilizing their primary care doctors and engaging in preventive medicine. This is when you are having patients focus on how their lifestyle choices could have an impact on their underlying levels of health. The way that this is accomplished is through: conducting routine physicals and encouraging patients to make changes in how they are living their lives (i.e. dietary and physical activity). (Landon, 2010, pp. 827 -- 834)