Unintended consequences of steps to cut readmissions and reform payment may threaten care of vulnerable older adults.
The US health care system is characterized by fragmentation and misaligned incentives, which creates challenges for both providers and recipients. These challenges are magnified for older adults who receive long-term services and supports. The Affordable Care Act attempts to address some of these challenges. We analyzed three provisions of the act: the Hospital Readmissions Reduction Program; the National Pilot Program on Payment Bundling; and the Community-Based Care Transitions Program. These three provisions were designed to enhance care transitions for the broader population of adults coping with chronic illness. We found that these provisions inadequately address the unique needs of vulnerable subgroup members who require long-term services and supports and, in some instances, could produce unintended consequences that would contribute to avoidable poor outcomes. We recommend that policy makers anticipate such unintended consequences and advance payment policies that integrate care. They should also prepare the delivery system to keep up with new requirements under the Affordable Care Act, by supporting providers in implementing evidence-based transitional care practices, recrafting strategic and operational plans, developing educational and other resources for frail older adults and their family caregivers, and integrating measurement and reporting requirements into performance systems.
New Courtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA. naylor@nursing.upenn.edu
Mary D
MD
Naylor
Ellen T
ET
Kurtzman
David C
DC
Grabowski
Charlene
C
Harrington
Mark
M
McClellan
Susan C
SC
Reinhard
D000368:Aged / Q000706:statistics & numerical data; D002908:Chronic Disease / Q000453:epidemiology / Q000628:therapy; D003153:Community Health Services / Q000379:methods / Q000458:organization & administration; D003266:Continuity of Patient Care / Q000458:organization & administration / Q000706:statistics & numerical data; D003695:Delivery of Health Care / Q000379:methods / Q000458:organization & administration; D019033:Delivery of Health Care, Integrated / Q000379:methods / Q000458:organization & administration; D018166:Health Care Reform / Q000379:methods / Q000458:organization & administration; D006291:Health Policy; D006801:Humans; D010359:Patient Readmission; D010865:Pilot Projects; D012051:Reimbursement Mechanisms / Q000458:organization & administration; D014481:United States; D035862:Vulnerable Populations