Transformational Promise of the Affordable Care Act for Homecare

One of the goals of the Affordable Care Act (ACA) is to reduce the fragmentation of services for patients. The problems of fragmentation are magnified for the six million Americans receiving long-term services.

What will be the impacts on this population of three provisions of the ACA–the Hospital Readmissions Reduction Program (Section 3025), the National Pilot Program on Payment Bundling (Section 3023), and the Community-Based Care Transitions Program (Section 3026). It finds that these provisions inadequately address the unique needs of Americans receiving long-term services, and, in some instances, produce unintended consequences that contribute to avoidable poor outcomes.

These provisions should enhance transitional care and prevent avoidable poor outcomes among the Medicare population, however; the Affordable Care Act may introduce unintended consequences for older adults receiving long-term services and supports. Should additional policies be drafted that address these potential emerging risks? Without retooling the payment and delivery systems, reform could fall short of its transformational promise.

The US health care system is characterized by fragmentation and misaligned incentives, which creates challenges for both providers and recipients. These challenges are magnified for older adults who receive long-term services and supports. The Affordable Care Act attempts to address some of these challenges. By analyzing three provisions of the act: the Hospital Readmissions Reduction Program; the National Pilot Program on Payment Bundling; and the Community-Based Care Transitions Program. These three provisions were designed to enhance care transitions for the broader population of adults coping with chronic illness.

Do these provisions adequately address the unique needs of vulnerable subgroup members who require long-term services? Could these provisions produce unintended consequences that would contribute to avoidable poor outcomes? Policy makers need to anticipate such unintended consequences and advance payment policies that integrate care. They should also prepare the delivery system to keep up with new requirements under the Affordable Care Act, by supporting providers in implementing evidence-based transitional care practices, recrafting strategic and operational plans, developing educational and other resources for frail older adults and their family caregivers, and integrating measurement and reporting requirements into performance systems.

Sunday Health Update from Health Affairs