State's new long-term care plan has plenty to talk about

In less than nine months, some 100,000 elderly or disabled southwestern Pennsylvanians will be affected by a change in how government-subsidized long-term care services are arranged for them.

Chances are they don’t know it yet, though plenty of other people are talking about the impact upon those Medicare and/or Medicaid beneficiaries who will fall under the new managed-care program known as Community HealthChoices. As has been done in numerous states, Pennsylvania is hoping to reduce use of expensive government-funded nursing home and hospital care by contracting with companies to manage individuals’ social supports and medical treatment. Better health maintenance guidance and in-home assistance is supposed to be a win-win for both the recipients of care and the state.

An array of health care insurers, service providers and consumer advocates discussed the topic Wednesday in a session set up by the Jewish Healthcare Foundation at its Downtown office. The subject is timely not just because of the Jan. 1 roll-out in the Pittsburgh region of the program to be phased in later elsewhere in the state; it’s because of all that has to happen before January.

The 13 managed-care organizations that have expressed potential interest in contracting with the state have a May 2 deadline to submit proposals if they want to participate in the Pittsburgh region. It may be just the seven that attended Wednesday’s session that will submit proposals, but state officials hope to end up selecting three to five of them to cover the southwest and thus provide options to consumers on which one will represent them.

In the meantime, the MCOs need to arrange networks of hospitals, nursing homes, home care agencies and others who will provide long-term care services for the clients the MCOs manage. And information will need to reach those clients this year explaining what Community HealthChoices is all about and how it will affect them individually, including the need for a relationship with a new coordinator who will monitor and manage what services they receive.

Accomplishing that in less than nine months sounded like an ambitious — but not impossible — timeline to a number of those attending Wednesday’s meeting, which offered something akin to speed dating for service providers, community organizations and others going from table to table manned by MCO representatives and peppering them with questions. A number of consumer advocates sought assurances that consumers in the program will have sufficient options and be well-educated about them, including the ability to dispute any limits put on their care.

But no one appeared to have concerns that Pennsylvania was on the wrong track with its Community HealthChoices goals.

“I’m feeling pretty positive that it’s going to help out a lot of consumers and streamline a lot of things,” said Fred Hess, an advocacy coordinator in New Castle for the Disability Options Network.

As for the MCOs, some are local, including UPMC Health Plan and Gateway Health Plan, but others with experience managing similar long-term care programs in other states would be new to the region. In either case, they’ve been meeting with all kinds of service providers to try to determine which ones they want taking care of clients.

Because of the new networks, consumers may have to switch eventually (it won’t happen Jan. 1 because of a phase-in period) from someone who has been delivering medical or home services to them. MCO representatives said Wednesday they would be contracting with providers they can trust as partners delivering quality care.

“The bottom line is to tailor care management down to the individual level for each person, trying to make sure they can be stable where they are and improve their quality of life,” said Joe Glinka, legislative director for Gateway.

Gary Rotstein: or 412-263-1255.


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