Seniors are more likely to have chronic conditions that require a variety of treatment and services. Unfortunately, much of this care is disjointed and fragmented which generally leads to poor quality, poor outcomes, and cost inefficiencies. Increasingly, both public and private payers are demanding robust care coordination for their enrollees.
Increase support for North Carolina’s senior residents by, (i) mandating high standard of care coordination requirements be written into contracts, (ii) enforcing nursing facilities participation in Advancing Excellence in America’s Nursing Homes Initiative and (iii) considering the linkAges support program.
i) In order to accelerate the inclusion of evidence based care coordination into the lives of North Carolina seniors, we must mandate that the Department of Health and Human Services include a high standard1 of care coordination requirements in all contracts with Prepaid Health Plans (PHPs). These contracts to commercial insurers or provider-led entities will be a result of a successful competitive bid to DHHS. These contracts will cover long term care services and supports and must require detailed plans for evidence based care coordination from the PHPs. The state of Oregon Health Authority mandates a screening and selection process to procure managed care services.2 North Carolina could use this as a basis for instituting regulations regarding contracts for PHPs.
ii) Nearly half of Medicaid expenditures for the elderly are for nursing facility care. Those facilities must provide person-centered quality-of-life care. To ensure the money spent provides high-quality care for our seniors, we must require North Carolina nursing facilities to participate in the Advancing Excellence in America's Nursing Homes Initiative.3 Only 51 percent of our nursing facilities currently participate, a number well below the national average.4
iii) Loneliness and isolation can have a devastating impact on the health and quality of life for seniors. Community based social support programs are a key feature in combating this isolation and one promising program is linkAges,5 which is designed by the Palo Alto Medical Foundation’s David Druker Center for Health Systems Innovation as a wide-ranging resource to help older Americans continue to live independently.
linkAges comprises four components:6 1) A TimeBank, through which participants provide neighborly services to each other to “build community and social connections”; 2) List, an online platform that provides content and reviews about “senior-relevant services and resources from social service and community-based databases”; 3) A Personal Profile for each participant; 4) and Connect, a passive in-home utility monitoring system intended to proactively detect changes in participants; physical and social health status. The Robert Wood Johnson Foundation awarded the Center a three-year $174,000 grant to fund Connect’s development and evaluation.
The linkAges program is currently being tested in the San Francisco Bay Area, and an evaluation of its impact on loneliness is due in 2016. In order to assess the feasibility to incorporate this program in communities across North Carolina, the North Carolina General Assembly should consider a study bill to request and support the NC Institute of Medicine in partnership with the Division of Aging and Adult Services to convene a multi-disciplinary task force to study healthy aging and aging in place.
1 National Quality Forum. "Care Coordination Measures."
2 Oregon Health Authority. "Oregon Health Plan (MCO and CCO) Administrative Rulebook."
4 Another program to consider is Program for All Inclusive Care for the Elderly (PACE).
5 The Commonwealth Fund. (September 2015). linkAges Senior Support Systems.
6 Hayes, Susan L., Douglas McCarthy, and Sarah Klein. (September 2015) linkAges: Building Support Systems for Seniors Living Independently in the Community. The Commonwealth Fund.