A Blueprint for Health Plans
Older adults often have complex medical and social needs, which are both intimately related, and inadequately addressed in the current health care system. Despite mounting evidence that supports the integration of the medical and social models of care, the transition to a more comprehensive delivery system has not been simple or intuitive for either health plans or social service providers. The result is that the delivery of services is confusing to navigate, and often remains uncoordinated and fragmented for the aging population, particularly for individuals that are eligible for both Medicare and Medicaid (dual eligibles).
Athena Chapman, President of Chapman Consulting, recently authored a report funded by The SCAN Foundation titled A Blueprint for Health Plans: Integration of CBOs to Provide Social Services and Supports. The report examines the opportunities and challenges that health plans face when integrating social services and supports and provides insights from both CBOs and health plans on how to develop networks that reflect both the social and medical needs of their dual-eligible members.
CBOs are trusted organizations within the community that have access to health plan members outside of the medical office setting, which helps identify non-medical member needs, such as home modifications or a recuperative care placement. If health plans strategically invest time and resources into the development of partnerships that provide access to social services and supports, it will drive system change that has the potential to greatly improve the overall health and reduce preventable adverse health outcomes for older adults and those with complex medical and social needs.
For sustainable relationships to be established and maintained between health plans and CBOs all stakeholders must be engaged in the conversation and feel their perspective is considered. This engagement will lead to the development of practical solutions that can be implemented by plans and social service providers and demonstrate the value of such arrangements for addressing the needs of the older adults with complex medical needs.
As we increase opportunities for more integrated care delivery and identify ways to expand the use of this model, both health plans and social service providers can deliver better services to the community and meet the mutual goals of better care, better outcomes, and lower costs to the system. However, significant barriers remain including operational and contracting issues, demonstrating a return on investment, regulatory barriers to full integration, and appropriate financing mechanisms to promote investment in social services and supports. There is great opportunity for regulators, health plans, CBOs, advocates, and other stakeholders to work together to define best practices and identify strategies to reduce barriers to the development of more integrated delivery systems that provide access to social services and supports.
Join Athena Chapman of Chapman Consulting on July 2 for a webinar hosted by The Aging and Disability Business Institute and the American Society on Aging to learn more about initiatives in California that aim to increase access to social services and supports, which elements are essential to implementing sustainable CBO and health plan partnerships, lessons learned along the way, and a discussion of solutions to regulatory and organizational barriers that prevent full integration of social services and supports. The webinar will highlight specific steps and strategies that can be employed by health plans, identify current best practices, and highlight opportunities for increasing social service provider networks and contracts. The goal is to promote policies and organizational changes that create a more integrated system of care for older adults with complex medical and social needs.
The Aging and Disability Business Institute is funded by:
Learn more about The Aging and Disability Business Institute at www.aginganddisabilitybusinessinstitute.org