Virtual Pace
Total Long
Term Care and Medical Costs
The total cost of people with long term care needs includes the costs of long term care services and medical costs. In Family Care, certain medical costs are included. Other medical costs are covered by Medicaid and Medicare if the individual is eligible for Medicare. There are interrelationships between long term care services, an individual’s attitudes and behaviors and an individual’s health. Medical costs and long term care costs are interdependent.
Northeast Wisconsin Family Care has a strong stewardship interest in positively impacting total costs including all long term costs and medical costs. We are interested in working with medical organizations that will be providing medical services to individuals with long term care needs that we will be serving.
The Department of Health Services also has this same interest. One of the projects the Department of Health Services is currently planning is known as “Virtual Pace.” The focus of Virtual Pace is on improving the coordination of long term care and medical services for individuals with long term care needs that are both Medicaid and Medicare eligible.
The following are materials and web linkages that provide information on this effort and are provided to increase understanding and to encourage discussions between managed care organizations and medical service providers.
Proposal for Innovative Demonstration Project for dual Medicaid/Medicare Members--Virtual Pace
2011-13 Medicaid Efficiencies Long Term Care Pilot Program - Virtual Pace
Integrating Care for Dual Eligible Medicare/Medicaid
Center for Health Care
Strategies (CHCS): Integrating Care for Dual Eligibles: An Online
Toolkit
http://www.chcs.org/publications3960/publications_show.htm?doc_id=606732
CMS Integrated Care Roadmap:
https://www.cms.gov/IntegratedCareInt/2_Integrated_Care_Roadmap.asp
National PACE Association
http://www.npaonline.org/website/article.asp?id=65
National Health Policy Group: Special Needs Plans (SNPs)
http://nhpg.org/
CMS: Financial Models Supporting Integrated Care
https://www.cms.gov/smdl/downloads/Financial_Models_Supporting
_Integrated_Care_SMD.pdf
CHCS: Supporting Integrated Care for Dual Eligibles
http://www.chcs.org/publications3960/publications_show.htm?doc_id=982564
CHCS: Options for Integrating Care for Dual Eligible Beneficiaries
http://www.chcs.org/publications3960/publications_show.htm?doc_id=1186550
CHCS: Supporting
Alternative Integrated Models for Dual Eligibles: A Legal Analysis
of Current and Future Options
http://www.chcs.org/publications3960/publications_show.htm?doc_id=1079026
Statement of Melanie
Bella, Director of the Medicare-Medicaid Coordination Office, CMS:
Dual-Eligibles: Understanding the Vulnerable Population and How to
Improve Their Care
Before the U.S. House Committee on Energy &
Commerce, Subcommittee on Health June 21, 2011
http://republicans.energycommerce.house.gov/Media/file/Hearings/Health/062111%20Dual%20Eligibles/Bella.pdf
CHCS: Profiles of State Innovation: Roadmap for Improving Systems of
Care for Dual Eligibles
http://www.chcs.org/publications3960/publications_show.htm?doc_id=1261189
CHCS: From the Beneficiary Perspective: Core Elements to Guide
Integrated Care for Dual Eligibles
http://www.chcs.org/publications3960/publications_show.htm?doc_id=1261212
CHCS: Integrated Care Program Design: A Checklist for States
http://www.chcs.org/publications3960/publications_show.htm?doc_id=378940
CHCS: Integrated Care Program: Performance Measures Recommendations
http://www.chcs.org/publications3960/publications_show.htm?doc_id=379026
CHCS: Integrated Care Program: Final Evaluation
http://www.chcs.org/publications3960/publications_show.htm?doc_id=714908
CHCS: Developing an Integrated Care Program for Dual Eligibles Using
Special Needs Plans
http://www.chcs.org/publications3960/publications_show.htm?doc_id=1261218
Kaiser Health News: When Care is Split Between Medicare and
Medicaid: KHN Interview with Melanie Bella
http://www.kaiserhealthnews.org/Stories/2011/February/24/Medicaid-medicare-dual-eligibles-Melanie-bella.aspx
Robert Wood Johnson Foundation: Medicare/Medicaid Integration
Program
http://www.rwjf.org/pr/product.jsp?id=35988
Integrating Medicare and Medicaid Services Through Managed
Care, CRS Report for Congress
http://www.policyarchive.org/handle/10207/bitstreams/18941.pdf
Medicare and Medicaid: Conlicting Incentives for
Long-Term Care
http://www.milbank.org/quarterly/Milbank%2085.4%20Grabowski.pdf
The Impact of Medicare Special Needs Plans on State
Procurement Strategies for Dually Eligible Beneficiaries in
Long-Term Care: Final Report
http://muskie.usm.maine.edu/Publications/MeicareSNP.pdf
Medicare Advantage Special Needs Plans for Dual Eligibles:
A Primer
http://www.commonwealthfund.org/Publications/Issue-Briefs/2008/Feb/Medicare-Advantage-Special-Needs-Plans-for-Dual-Eligibles--A-Primer.aspx
Medicare at a Glance
http://www.kff.org/medicare/upload/1066-14.pdf
Medicare Advantage at a Glance
http://www.kff.org/medicare/upload/2052-15.pdf
Tutorial: Medicare 101, The Kaiser Family Foundation
http://www.kff.org/medicare/med062509oth.cfm
