title: An Assessment of State-Led Reform of Long-Term Services and Supports.
abstract: Health care in the United States is fragmented, inefficient, and rife with quality concerns. These shortcomings have particularly serious implications for adults with disabilities and functionally impaired older adults in need of long-term services and supports (LTSS). Three strategies have been commonly pursued by state governments to improve LTSS: expanding noninstitutional care, integrating payment and care delivery, and realigning incentives through market-based reforms. These strategies were analyzed using an evaluation framework consisting of the following dimensions: ease of access; choice of setting/provider; quality of care/life; support for family caregivers; effective transitions among multiple providers and across settings; reductions in racial/ethnic disparities; cost-effectiveness; political feasibility; and implementability. Although the analysis highlights potential benefits and drawbacks associated with each strategy, the limited breadth of the evidentiary base precludes an assessment of impact across all nine dimensions. More importantly, the analysis exposes the interdependent, complex system of care within which LTSS is situated, suggesting that policy makers will require a holistic and long-term perspective to achieve needed changes. Addressing the nation's LTSS needs will require a multipronged strategy incorporating a range of health and social services to meet the complex care needs of a diverse population in a variety of settings.
authors.affiliation: University of Pennsylvania.
authors.forename: Mary D
authors.initials: MD
authors.lastname: Naylor
authors.affiliation: George Washington University.
authors.forename: Ellen T
authors.initials: ET
authors.lastname: Kurtzman
authors.forename: Edward Alan
authors.initials: EA
authors.lastname: Miller
authors.affiliation: University of Massachusetts, Boston.
authors.forename: Pamela
authors.initials: P
authors.lastname: Nadash
authors.affiliation: National PACE Association.
authors.forename: Peter
authors.initials: P
authors.lastname: Fitzgerald
mesh_terms: D003362:Cost-Benefit Analysis; D005190:Family; D018166:Health Care Reform / Q000458:organization & administration*; D006297:Health Services Accessibility / Q000191:economics / Q000458:organization & administration*; D054625:Healthcare Disparities; D006801:Humans; D007349:Insurance, Health, Reimbursement; D008134:Long-Term Care / Q000191:economics / Q000458:organization & administration*; D057240:Patient Preference; D011057:Politics; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000458:organization & administration; D011788:Quality of Life; D044469:Racial Groups; D012947:Social Work / Q000191:economics / Q000458:organization & administration*; D013219:State Government; D014481:United States
keywords: health care quality; health care reform; long-term care; long-term services and supports; report card; state government