Integrating long-term care services in Virginia's health care reform plan

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 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)

Over the course of time, this strategy would produce lower costs and it will increase the quality of services that are being provided. Evidence of this can be seen with a study that was conducted by Phillips (2010) he found that short-term spending increases of 10 to 12% in primary care infrastructure will result in long-term decreases in prices. The reason why is because, these expenses are helping to improve efficiency and they are changing the culture inside many facilities. Once this occurs, it means that there will be various procedures in place to address growing demand for these services. At the same time, this is allowing for the system to shift the majority of patients to primary care doctors (based on the fact that they do not require the use of a specialist). These different elements are important, because they are showing how the health care sector would be more able to adapt to changes in the future and improve treatment options. (Phillips, 2010, pp. 806 -- 810)

How this can be implemented on the Local Levels?

Like what was stated previously, the program that we are going to be enacting will have the state providing general guidelines and the local communities determining how these solutions can be implemented (within state provisions). The way that this will be accomplished is by having various community health boards established. They will determine the health care solutions that will be provided in select areas. This will be composed of: local officials and members of the general public. They will make specific recommendations and will provide funding for various programs to: address the health care demands of the community. (Liu, 2008, pp. 124 -- 130)

For example, if a city has been using different health care providers to deliver various dietician services to primary care patients suffering from obesity, while their cost are increasing. The board has the option of seeking out nonprofit organizations and other corporations that could provide these services to the community. If this kind of approach was taken, it will ensure that costs will remain low and local communities will have the responsibility for monitoring as well as determining how these services will be delivered. This will provide the public with more choices and it will lower the prices that are being paid for a wide variety of services. (Liu, 2008, pp. 124 -- 130)

To prevent any kind of abuse or fraud, these boards would fall under the jurisdictions of the Long-Term Care Committees and government agencies. This will ensure that there is accountability and that these funds are utilized in areas are benefiting everyone (versus a select group). Over the course of time, this will help to provide the highest quality services, while mitigating any kind of possible scams on the system. (Liu, 2008, pp. 124 -- 130)

Clearly, the most effective way that the State of Virginia can address the underlying challenges from rising health care costs is through: the integration of various services. The best way to achieve this objective is to integrate them together. These include: primary care, long-term care, the use of specialists, prescription drugs, dental and vision services. The strategy that we have outlined can help to integrate these elements as a part of the total health care solution. To achieve this objective, various forms of taxes could be imposed on those products that help to contribute to the increase in costs (i.e. The use of tobacco and alcohol). The state could provide a general outline, as to how these services should be delivered to the community. This will be accomplished through: community boards and having them decide how to address the needs of the general public. If this kind of approach was used, it will help to reduce the long-term issues of rising costs and increasing demand. Over the course of time, this will give the general public greater choices about the kinds of services that are offered and the prices they are paying. This is when the state can be able to effectively control health care costs and adjust to the challenges that they are facing in the future. ("Integration of Acute and Long-Term Care," 2011)