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Of Geriatric Care Management Fall 2013 VOLUME 23 ISSUE 2 FALL 2013 Published by the National Association of Professional Geriatric Care of Managers 3275 West Ina Road Suite 130 Tucson, Arizona Geriatric Care Management 85741 520.881.8008 / phone 520.325.7925 / fax www.caremanager.org Care Management and the Affordable Care Act (ACA) The Possibilities, The Realities, and The Concerns Guest Editor’s Message ..............................................................................2 Carol S. Heape, MSW, CMC Care Coordination Under the Affordable Care Act: Opportunities and Challenges for Geriatric Care Managers .......................5 Susan Emmer, Legislative Consultant NAPGCM A CLASS Act – Development until the Aftermath of its Demise ..................9 Regina M. Curran, MA, CMC The Affordable Care Act: Shaking Up the System Provides Opportunities for Care Management .........................................................14 Michael Newell, RN, MSN The Affordable Care Act and Its Impact on Care Management .................18 Eric C. Rackow, MD & Claudia Fine, LSCW, MPH, CMC Beware of What You Wish for OR The Affordable Care Act and Me .........24 Phyllis Mensh Brostoff, CISW, CMC Understanding National Health Reform: Why Big Data isn’t Enough ........27 Natasha Dorgin, MD/PhD Candidate & Kate Lapane PhD Effects on Medicare Clients & The Affordable Care Act (ACA) ................32 Carol S. Heape, MSW, CMC of Geriatric Care Management Fall 2013 Guest Editor’s Message Carol S. Heape, MSW, CMC, Fellow “The Patient Protection and to come in future months. and recognize the complexity of this legislation and how it is predicted to Affordable Care Act (ACA) is “The bill itself has many components, some of which are change healthcare as the U.S. knows the most significant health- complex topics unto themselves and it. This will also change for them care legislation enacted since involve multi-year schedules. Some how care management is viewed and create new federal offices, and others how those views will change society’s the passage of Medicare and confer authority to pursue goals and expectations. Finally, whether you, Medicaid forty-five years ago. concepts, rather than containing the Geriatric Care Manager are a sole specific program proposals. As a practitioner, consider yourself a small The new law’s full implications business with several employees, 1 result, most people at the community will not be known for years...” level did not understand the bill or the are part of a larger care management planning that went into it well enough firm or healthcare system, or are the to be able to clarify it for others.” 2 founder or owner of a large company he Affordable Care Act (ACA) offering care management, home care, is in the news almost daily as For Geriatric Care Manag- conservatorship, fiduciary services, Tits implementation approaches. ers (GCM), the ACA means one set etc., you must pay attention! The It is a moving target; with facets and of issues for their clients, the great ACA is large, complex, and has as- timelines changing in some ways in majority of whom are on Medicare. pects that will affect all Care Manag- a domino effect. Regardless of the However, Geriatric Care Managers are ers personally and professionally. controversy surrounding this massive also business owners looking for new legislation, it lumbers forward with opportunities to serve clients and per- “This legislation is not perfect. changes that already have been in haps expand their practice to include Many social workers supported a effect for several years i.e., those other populations. Care Managers are single-payer system or, at minimum, occurring this fall and more scheduled also very aware of the “world at large” continued on page 3 EDITORIAL BOARD Rona Bartelstone, LCSW, CMC, C-ASWCM Fort Lauderdale, FL Phyllis Mensh Brostoff, CISW, CMC Milwaukee, WI Cathy Cress, MSW Santa Cruz, CA Lenard W. Kaye, PhD Orono, ME of Karen Knutson, MSN, MBA, RN Bryn Mawr, PA Betty Landreaux, MSSA, LCSW, CMC, NCG Journal Metairie, LA Emily Saltz, MSW, LICSW, CMC Geriatric Care Management Newton, MA Published by the: Jennifer Pilcher Warren, MS, PhD, CMC Lincoln, MA National Association of Professional Geriatric Care Managers Monika White, PhD 3275 West Ina Road, Suite 130, Tucson, Arizona 85741 • www.caremanager.org Santa Monica, CA © Copyright 2013 EDITOR-IN-CHIEF Suzanne Modigliani, LICSW, CMC The Journal of Geriatric Care Management is published two times per year as a Brookline, MA membership benefit to members of the National Association of Professional Geratric Care Managers. Non-members may subscribe to Journal of Geriatric Care Management for GRAPHIC DESIGN $95.00 per year. Send a check for your one-year subscription to: Subscription Department, HagerDesigns NAPGCM, 3275 West Ina Road, Suite 130, Tucson, Arizona 85741. Dallas, Texas PAGE 2 of Fall 2013 Geriatric Care Management Geriatric Care Management be fragmented with no overall public data collection, statistics, and track- and the Affordable Care Act program in place to address long-term ing outcomes can move the profes- continued from page 2 care needs for all older Americans sion upward to the point of being who wish to age in place in their own recognized as the profession it is. The adding a public option to the ACA. homes. authors have addressed this shortfall Despite this, the legislation provides a Building on Emmer’s article and write an important message to critical framework for addressing our on the ways “person-centered care” Care Managers about the opportunity nation’s healthcare issues.” 3 and care coordination are included to participate with this effort. Through Susan Emmer, Legislative Con- throughout various aspects of the their data collection and development sultant to NAPGCM begins her article, ACA, Michael Newell, RN, MSN, of predictive models, Humana Cares/ “Care Coordination Under the Afford- “The Affordable Care Act: Shaking SeniorBridge has been able to ad- able Care Act: Opportunities & Chal- Up the System Provides Opportuni- dress these issues as well as the 30 lenges for Geriatric Care Managers” ties for Care Management” writes day readmission problem. Finally, it with a historical perspective of what how the changes occurring prior to the brings Geriatric Care Managers back to tracking statistics, diagnoses, and care coordination looked like prior to ACA have set the stage for potential identifying common problems care the passage of the ACA in 2010. She involvement and opportunities for recipients and Care Managers face brings us forward to the aspects of Geriatric care managers. Patient- together. In conclusion, these authors the ACA that focus on care coordina- centered care, Newell writes is “care stress the need for consistent, mea- tion and describes care management/ that is respectful of and responsive to surable outcomes that will track the care coordination programs such as individual patient preferences, needs processes and demonstrate a positive Community-based Care Transitions and values.” The concept of patient- outcome. Program (CTP), Affordable Care centered empowers the individual to Organizations (ACO), Health Care In- keep and review their own Personal In her article, Phyllis Brostoff ex- novation Awards, Navigator Program, Health Record brought about through amines the ACA from an employer’s Money Follows the Person, and oth- the advent of the HITECH Act and perspective, “Beware of What You ers. Her article not only explains the electronic health records (EHR). Wish For OR The Affordable Care Act terms and a summary of the programs Although challenges remain, Geriatric and Me” anticipating that by 2015, but she offers an encouraging chal- Care Managers have already begun her company will have to comply with lenge to Geriatric Care Managers to working with the EHR with their cli- the mandates set up for employers learn about new programs within the ent. Funding was included with the with 50 or more full time employ- changing healthcare landscape that ACA to facilitate and further reinforce ees. As a social worker and larger will utilize the expertise and commu- the EHR concept. Newell’s article company employer, Brostoff writes nity knowledge of the Care Manager. further explains existing and pilot of her philosophy of having universal Since 2000, Regina Curran, MA, projects and the potential develop- health coverage for everyone. Now CMC, “A CLASS Act – Development ment of opportunities for Geriatric however, she is facing the reality of Until the Aftermath of its Demise,” Care Managers around the country to an employer who has offered health has represented NAPGCM in the become involved within the contexts insurance as a benefit to employees for Leadership Council of Aging Orga- of their practice and community/state some time that now may not be suf- nizations. Curran, with NAPGCM programs being implemented for care ficient to comply with the mandates of Legislative Consultant Susan Em- coordination. the ACA. The story is not unfamiliar mer, continues to educate NAPGCM to many of us who started companies “The Affordable Care Act and as a sole practitioner, added Care membership about aging policy as Its Impact on Care Management,” well as working to have the NAPGCM Managers and administrative staff as Eric Rackow, MD and Claudia Fine, employees and then made the decision voice be heard nationally. Regina LSCW, MPH, CMC of Humana to add the home care component. In writes about national long-term care Cares/SeniorBridge shows the extent her article, Brostoff gives the specifics policy
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