Can Health Plans that Address Non-Medical Needs Lower Health Care Costs?

Authors
Jennifer Windh
G. Lawrence Atkins
Anne Tumlinson
Jennifer Wolff
Amber Willink
John Mulcahy
Technical Assistance Tool
May 2019

This resource describes a study of five plans that integrate LTSS into care. The study examined differences in medical utilization by beneficiaries, compared to a population with a similar level of functional impairment but enrolled in traditional Medicare.

  • The study looked at three kinds of medical utilization: hospitalizations, emergency department visits, and skilled nursing facility admissions.
  • It found generally lower medical utilization rates for enrollees with functional limitations in integrated plans than predicted for a similar population in traditional Medicare.
  • Each of the plans had some rates that were lower, but no plan had lower rates across the board, and the rates that were lower varied by type of plan. Differences in how the plans structure and implement LTSS integration may influence whether the plan has lower rates for ED visits, hospitalizations, or SNF admissions.
  • Possible relevant factors are how long a plan has been operating, the care model, and the population served.
Posted to The Playbook on
Population Addressed
Adults Under 65 with Disabilities
Frail Older Adults
People with Multiple Chronic Conditions
People with Behavioral Health and Social Needs
Key Questions Answered
  • Do plans that integrate long-term services and supports (LTSS) into care help reduce medical utilization?
  • What factors might affect the effectiveness of plans?
Level of Evidence
Expert Opinion
What does this mean?