Models for Integrating and Managing Acute and Long-Term Care Services in Rural Areas

Abstract

States and the federal government are searching for new managed-care strategies, such as capitated financing and coordinated case management, that integrate the financing and delivery of primary, acute, and long-term care services. For rural communities, the development of organizational and delivery systems, which better integrate and manage primary, acute, and long term care services, may help address long-standing problems of limited access to long-term care services. This article discusses the concept of integrated acute (medical) and long-term care service networks; model programs; challenges that health care providers, state policymakers, and others have faced in developing these new integrated structures; and the future of service-integration and coordination approaches in rural areas.

Ten Key Principles for Successful Health Systems Integration

“…Closely related to the issue of interprofessional collaboration is communication (Appleby et al 1999;Coburn 2001;O'Connell et al 2000;Stewart et al 2003). Barnsley et al emphasize the importance of "an organic structure with diverse communication channels that efficiently transfer information across organizational boundaries" (1998: 19).…”

“…Barnsley et al emphasize the importance of "an organic structure with diverse communication channels that efficiently transfer information across organizational boundaries" (1998: 19). Colocation of services (Appleby et al 1999;Coburn 2001;Kolbasovsky and Reich 2005), frequent team meetings (Baxter et al 2002) and the use of electronic information systems facilitate effective communication (Coburn 2001;Coddington 2001c;Hurst et al 2002;Lin and Wan 1999).…”

“…Clashing cultures, such as differences between providers of medical services and long-term care services (Hardy et al 1999;Coburn 2001), or between physicians and other service providers (Friedman and Goes 2001;Hawkins 1998), is one of the reasons named for failed integration efforts. Another cultural barrier to integration is an acute care mindset, which places the hospital at the centre of the integration process (Shortell et al 1993).…”

“…It was believed that integrated health systems would result in economic benefits because of economies of scale and cost reductions in both administrative and clinical areas (Coburn 2001). Many authors claim, however, that integration processes may result in increased costs before they provide savings (Coburn 2001). The way services are funded is therefore an important consideration of integrated models (Leatt et al 2000).…”

Financing and Payment Issues in Rural Long-Term Care Integration

“…The partial capitation was developed to provide flexibility to the providers in designing service and care plans that met the needs of the patients without being constrained by the fee for service structure of payments and service delivery. (Coburn, 1998) HCFA has expressed interest in testing broader applications of Medicare partial capitation. Negotiations are currently underway with Massachusetts to develop a partially capitated Medicare payment as part of the State's Senior Care Organization (SCO) demonstration.…”