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  The SCAN Foundation / DataBriefs on Residence Setting, Level of Disability, and Healthcare Utilization
  

  This data, produced by Avalere Health and released as part of The SCAN Foundation's DataBriefs series, illustrates the differences in care coordination, number of hospitalizations, and total Medicare spending on seniors with disabilities who receive care in nursing homes, at their own home or in a community care setting such as assisted living facilities, domiciliary care facilities, or continuing care retirement communities. The data show only 38 percent of older Americans with moderate or severe disabilities reside in nursing homes while another 58 percent choose to receive care at home or in community settings. Americans with disabilities living in community care settings also require more Medicare spending than similar older adults living in nursing facilities or those receiving care at home. The data analyses are based on the 2006 Medicare Current Beneficiary Survey (MCBS) Cost and Use file, an annual, longitudinal survey of a representative sample of all Medicare enrollees.

  
  
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  Avalere Health / Impact of Fiscal Year 2012 Skilled Nursing Facility Final Rule and Potential Medicaid Reductions on Nursing Facility Industry-wide Overall Margin
  

  This analysis by Avalere Health estimates that the Medicare payment rate reduction and change to group therapy policy in the FY 2012 Skilled Nursing Facility (SNF) Prospective Payment System final rule, published by the Centers for Medicare and Medicaid Services, will reduce the nursing facility industry-wide overall margin from 3.8 percent to zero in FY 2012, and from 4.4 percent to 0.4 percent in FY 2014. Potential Medicaid reductions and an additional 2 percent Medicare payment rate cut that could be imposed pursuant to the sequestration in the Budget Control Act of 2011 would further reduce the nursing facility overall margin to -2.2 percent in FY 2014.

  
  
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  Avalere Health / Impact of Fiscal Year 2012 Skilled Nursing Facility Final Rule on Payments to Nursing Facilities
  

  This analysis by Avalere Health finds that nursing homes will lose more than $79 billion in funding over the next 10 years. The reduction in payments stems from a recent rule (FY 2012 Skilled Nursing Facility (SNF) Prospective Payment System) published by the Centers for Medicare and Medicaid Services, which will lower nursing facility payment rates, resulting in a loss of more than $60 billion over 10 years. A change in this rule regarding allocation of group therapy minutes will reduce payments to nursing facilities by an additional $19 billion over the same time period. Furthermore, the analysis estimates the impact on economic activity and finds that the changes in the rule will result in a reduction of almost $7 billion in economic activity nationwide.

  
  
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  The SCAN Foundation / Technical Assumptions Informing an Interactive, Web-based Model of Public Long-Term Care Insurance Programs
  

  This paper outlines the technical assumptions behind the Long-Term Care Policy Simulator (LTCPS), a model constructed for the SCAN Foundation to estimate premiums and effects on the Federal budget of a variety of long-term care reform plans. The model allows users to create a mandatory or optional public long-term care insurance plan, with varying benefit amounts, participation requirements, benefit durations and other variables. The technical paper outlines the methods and data sources used to construct the estimates.

  
  
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  Avalere Health / Piloting Bundled Medicare Payments for Hospital and Post-Hospital Care / A Study of Two Conditions Raises Key Policy Design Considerations
  

  The Affordable Care Act requires the Centers for Medicare and Medicaid Services to conduct a demonstration program that would “bundle” payments for an episode of hospital care and for a certain number of days of post-hospital care. CMS must select episode lengths that are appropriate for the clinical needs of potential patients. This self-funded paper examines how many days should be covered under a bundle, using two common conditions that have high rehospitalization rates as a case study. An episode length of 30 days would be appropriate for most joint replacement or COPD patients. However, a quarter of patients with these two conditions have very complex care needs and need treatment for much longer periods. A more tailored bundle design is required for this subpopulation, pointing to important policy questions about how to best address the very clinically complex in a world of bundled payment.

  
  
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  The SCAN Foundation / Long-Term Care in Health Care Reform: Policy Options to Improve Both
  

  This paper, supported by a grant from the SCAN Foundation, makes the case for including long-term care provisions in health reform. Few Americans have insurance coverage for long-term care. In addition, acute care, post-acute care and long-term care are poorly coordinated, especially for the frail dual-eligibles, who are covered by both Medicare and Medicaid. The paper outlines proposals to increase the availability of home- and community-based services (HCBS) in Medicaid, to better coordinate medical and long-term care for Medicare enrollees in general and for dual eligibles in particular, and to establish a public long-term care insurance program. The paper concludes that health reform cannot fully accomplish its goal to improve the health and economic security of American families without addressing long-term care.

  
  
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  Henry J. Kaiser Family Foundation / Closing the Long-Term Care Funding Gap: The Challenge of Private Long-Term Care Insurance
  

  This report provides an overview of long-term care (LTC) insurance offerings, using expert interviews, 2008 premium data from the largest carriers, and a literature review to explore key challenges policymakers face in widening the role of private LTC insurance. According to the report, cost is a significant barrier to obtaining LTC insurance and becomes a bigger hurdle as people age. For individuals with no partner, the annual premiums for a typical policy averaged $2,329 at 60 and $4,515 at age 70. According to the report, policymakers interested in making private LTC insurance more affordable could consider supplementing coverage, offering tax credits toward purchase of LTC insurance, or providing direct premium subsidies.

  
  
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  SCAN Foundation / Long-Term Care --- an Essential Element of Healthcare Reform
  

  This chart book examines the role of long-term care in broader healthcare reform efforts. Through original and secondary research, the authors focused on four key points: long-term care users constitute the majority of Medicaid spending; home health and hospice Medicare post-acute care services may fill-in for long-term care; Medicare and Medicaid spending for dual eligible beneficiaries is often uncoordinated; and a significant amount of long-term care has been financed privately. Researchers conclude that reform efforts should carefully consider the healthcare needs of the long-term care population as well as leveraging private financial resources in order to strengthen the long-term care system.

  
  
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  Georgetown University / Linking Medicare and Private Health Insurance for Long-Term Care
  

  This paper proposes that a restructured Medicare could offer catastrophic long-term care coverage if beneficiaries purchase a pre-approved private long-term care insurance policy. The core concept involves two steps:  redeploying certain entitlement funding to create catastrophic long-term care coverage and leveraging the purchasing clout of the Medicare population to create a more favorable environment for private long-term care insurance. The authors posit that this public-private approach to long-term care financing reform is a sustainable way to simultaneously protect consumers from catastrophic costs of chronic illness and better develop the private insurance marketplace.

  
  
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  National Commission for Quality Long-Term Care / Long-Term Care in America / An Introduction
  

  This report examines the challenges of providing and financing long-term care against the backdrop of a rapidly aging society and resource-constrained entitlement programs. Created for a broad non-partisan commission, the authors stress the growing diversity of home-like settings with varied levels of federal regulation, transformation of nursing homes into post-medical, rehabilitative centers of care, and dominance of public programs together with donated care and out-of-pocket spending as primary ways to pay for long-term care. The report also focuses on the economic and demographic challenges which may further tax existing long-term care providers and the patients they serve. Policymakers and stakeholders in the long-term and post-acute care settings can use the report as a fact-based platform from which they can make assess system reform proposals and recommendations.

  
  
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  Kaiser Family Foundation / Frontline Perspectives on Long-Term Care Financing Decisions and Medicaid Assets Transfer Practices
  

  This report examines Medicaid asset transfers rules, and how recent legislative changes to tighten asset transfer practices will impact seniors and Medicaid.  The study, which features interviews with long term care planners in six states, found that most people have not planned for their long-term care needs and are unaware of their options; private long-term care insurance is too expensive for low and middle-income families; and personal resources and family care-giving play important roles in providing long-term care services, but have limits.  Current legislative efforts to tighten asset transfers must be coupled with enhanced national consumer education efforts and the creation of more affordable options to effectively reduce seniors’ reliance on Medicaid funding. 

  
  
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  The Pew Charitable Trusts / The Long-Term Care Partnership Program: Issues and Options
  

  In the context of Medicaid reform and state budget crises, policy makers are debating the merits of expanding the Long-Term Care Partnership Program, currently limited to four states, to all fifty states. The Partnership was designed to shift some of the financing of long-term care (LTC) from public sources to the private sector by encouraging individuals to purchase long-term care insurance. This issue brief examines the program goals of the four Partnership states and concludes that the Partnership should be considered as one of many tools states can employ in their efforts to reform Medicaid financing of LTC.

  
  
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  The Alliance for Quality Nursing Home Care / Implementing the Quality First Pledge
  

  As part of a broader initiative to improve the quality of nursing home care in the United States, the Alliance for Quality Nursing Home Care ("the Alliance") developed the Quality First Pledge and Code of Conduct in July 2002. Based on seven principles, the Quality First Pledge and Code of Conduct outline specific and measurable steps that Pledge signatories must take to improve quality outcomes in nursing facilities over time. This report outlines the findings from a baseline assessment of the Alliance member organization’s progress toward meeting the elements of the Quality First Pledge. This assessment was intended to assist participating organizations and the Alliance leadership in identifying (1) where companies have successfully met the elements of the Pledge, (2) where companies are not successfully meeting the elements of the Pledge, and (3) which recommendations may help Alliance companies make progress toward fully implementing each element of the Quality First Pledge.

  
  
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  The Kaiser Family Foundation / Recent Growth in Medicaid Home and Community Based Service Waivers
  

  This report describes changes in Medicaid home and community-based (HCBS) waiver program spending and participation over the last decade. The report also describes the unique attributes of HCBS waiver programs and how states use these attributes to target specific populations groups such as the physically disabled and persons with developmental disabilities. Based on a survey of waiver program administrators with details about the size and average time spent on waiting lists in 2002 for 171 HCBS waiver programs, the report concludes that use of this authority has expanded significantly over the past decade.

  
  
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  The Pew Charitable Trusts / Linking Reverse Mortgages and Long-Term Care Insurance
  

  This report is intended to educate policymakers and major stakeholder groups about reverse mortgages, long-term care insurance, and the opportunities and challenges of implementing the program linking the two. The report concludes that using a reverse mortgage to fund long-term care insurance will be suitable for only a limited number of consumers, and that consumer education and counseling are critical for the appropriate implementation of this policy.

  
  
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  Center for Health Care Strategies / Integrating Quality Into Pharmacy Cost Containment Initiatives in the Nursing Home Setting
  

  The implementation of prescription drug cost-containment strategies in nursing homes represents new ground for states seeking to reduce Medicaid spending. As more states look to control spending in this environment, understanding how quality components can be integrated into emerging program designs becomes increasingly important. This brief provides an overview of the issues involved with designing and implementing clinical pharmacy management programs in nursing homes as well as examines successful examples of nursing home clinical pharmacy management programs.

  
  
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  National Health Policy Forum / Prescription Drug Use in Nursing Homes: Facts and Issues
  

  Although quality and cost issues related to prescription drugs have received increased attention in recent years, little is known about the specific issues related to prescription drug use in nursing homes. This policy brief explores various topics surrounding prescription drug utilization in nursing homes, including drug therapy, financing, the supply-chain, and quality issues specific to this setting.

  
  
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  Center for Health Care Strategies / The Essential Elements of Cost Estimation
  

  Responding to the U.S. Supreme Court's Olmstead v L.C. decision, states are moving toward establishing or expanding home or community-based long-term care programs. This toolkit can help states identify the factors that determine the costs for these programs. The toolkit also provides examples and suggests data sources for collecting information states will need as they estimate their programs' effects.

  
  

On June 1, 2005, we changed the name of our group to Avalere Health. All publications issued prior to that date contain our previous name, The Health Strategies Consultancy LLC.