Building on What Works

With a growing consensus on the threat of skyrocketing health-care costs, it's encouraging to see the development and increased awareness of new reform solutions that can actually improve the quality of care people receive while reducing or controlling costs.

According to a recent study reported in the New England Journal of Medicine, one-fifth of Medicare beneficiaries are re-hospitalized within 30 days of discharge, and one-third had to return within 90 days. All told, these preventable hospital readmissions cost Medicare more than $17 billion.

The AARP Public Policy Institute also surveyed chronically ill patients and their caregivers and highlighted problems that frequently occur during care transitions--when a patient moves from home to a hospital, between facilities, or back into their home. The survey found that more than one in five (21 percent) of chronically ill patients felt their health care providers did not do a good job communicating with each other, and poor communication between providers and their patients contributed to readmissions for nearly 15 percent of patients.

Fortunately, health care innovators like Dr. Mary Naylor at the University of Pennsylvania have been working on solutions that would help. By providing better information, support, and care coordination to patients and caregivers--starting before they leave the hospital--we can prevent avoidable hospital re-admissions, improve their health, and potentially save billions of dollars in the process.

This approach is the heart of the bipartisan Medicare Transitional Care Act of 2009 which would create a follow-up care benefit for high-risk patients in Medicare.

We are also encouraged by the growing awareness that home and community-based services (HCBS) can provide a win-win solution for the vexing problem of long-term care.

Under current law, Medicaid--the largest payer of long-term care--has an institutional bias. While states must provide coverage of nursing facility services, they do not have to cover most home and community-based services. On average, Medicaid can pay for three older people in HCBS for every one person in a nursing home. Despite this, HCBS is often one of the first programs to lose state funding during an economic downturn, often forcing more people into generally higher cost nursing facilities even if they would prefer to remain at home.

It's shameful that so many people are forced into nursing homes when we could improve their quality of life and typically spend less money by caring for them at home. That's why AARP has endorsed the bipartisan Empowered at Home Act and the Home and Community Balanced Incentives Act, both of which would provide incentives and greater opportunities for states to expand access to home and community-based services. They would also provide the spouses of people receiving HCBS with protection against impoverishment.

Only in an issue as complex as health care can common sense seem so innovative. Let's build reform on what works to make sure every American has access to quality, affordable health care choices.

By Nancy LeaMond  |  July 1, 2009; 5:19 PM ET  | Category:  Health Care Reform , Medicare
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