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Putting the Consumer First: Consumer Direction in Long-Term Care

Putting the Consumer First: Consumer Direction in Long-Term Care. March 31, 2009 Chuck Milligan Innovation in Health Policy Series DC Department of Health Care Finance. Overview. Portrait of Long-Term Care Consumer Direction Two Examples from Mi Via (from DVD)

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Putting the Consumer First: Consumer Direction in Long-Term Care

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  1. Putting the Consumer First:Consumer Direction in Long-Term Care March 31, 2009 Chuck Milligan Innovation in Health Policy Series DC Department of Health Care Finance

  2. Overview Portrait of Long-Term Care Consumer Direction Two Examples from Mi Via (from DVD) Needed Functions and Competencies -2-

  3. Portrait of Long-Term Care

  4. Medicaid and Medicare are the major third-party payers for long-term care, and out-of-pocket is high. -4-

  5. Expenditures in Medicaid long-term care continue to grow, especially for community-based services. -5-

  6. Medicaid is the largest payer for nursing home care. -6-

  7. 36 percent of Medicaid expenditures, or about $109 billion, goes toward long-term care . . . -7-

  8. Distribution of Medicaid LTC Dollars, FY 2007 % Community-Based % Institution-Based DC utilizes institutional services at a higher-than-average rate. DC ranks 40th out of 51 Source: Thomson Reuters

  9. Consumer Direction

  10. Aspects of Consumer Direction • More flexibility in benefit design • Still subject to some level of approval/oversight • Agency must balance: serving beneficiaries and serving taxpayers • More control of benefit choices and use • Have sufficient independence from provider? • Overuse? Underuse? • More control of prices • Have sufficient “market power”? • Have sufficient independence from provider?

  11. Two Examples from Mi Via (from DVD)

  12. Needed Functions and Competencies

  13. Functions and Competencies • Financial management • Review purchases • Connect to plans of care • Receive and process invoices, connected to plans of care • Protect against fraud & abuse by provider and/or beneficiary • Counseling • Assist beneficiaries in developing budgets and making decisions • Assist beneficiaries in hiring, firing, training, & scheduling workers • Market role • Monitor prices and supplier behavior • Determine credentialing standards for paid providers

  14. Contact Information Charles Milligan Executive Director The Hilltop Institute University of Maryland, Baltimore County (UMBC) 410.455.6274 cmilligan@hilltop.umbc.edu www.hilltopinstitute.org -14-

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