A century ago, children were lucky to have a ball or a stick to play with. The idea of setting up a public playground was a relatively new concept.
Then the baby boomers came along, and suddenly communities took a new interest in the construction and quality of playgrounds.
Today, the demographic forces that changed the nation's playgrounds are starting to change the way the United States thinks about overseeing long-term care (LTC) facilities and home care services -- at a time when cost constraints make providing even a cot in a warm, dry warehouse challenging.
Debra Lipson, an analyst at Mathematica Policy Research, Princeton, N.J., and colleagues look at state efforts to oversee Medicaid managed LTC services in a report posted on the Web by a think tank affiliated with AARP, Washington.
The federal government has been encouraging states to try using managed care contractors to hold down the cost of paying for LTC services for Medicaid enrollees.
Some of these enrollees are just plain poor; some used "Medicaid planning" to make themselves artificially poor, so that they could qualify for Medicaid nursing home benefits; and some are people who bought private long-term care insurance (LTCI) but ended up exhausting the pot of private benefits and qualifying for Medicaid.
LTCI carriers have been experimenting with using managed care strategies of their own to help maximize the benefits bang for the premium buck.
One question has been: How can managed LTC program overseers make sure that the programs provide high-quality care for patients who may have little ability to speak for themselves?
Lipson and the other analysts studied the performance of well-established Medicaid managed LTC programs in 8 states -- Arizona, Massachusetts, Minnesota, New Mexico, New York, Tennessee, Texas and Wisconsin. The analysts came up with recommendations about the process state regulators could use to set up effective managed LTC oversight programs.
The analysts say that most state Medicaid programs have been combining managed LTC oversight with medical managed care oversight; that the regulators need to have a high level of program management, quality assessment and computer skills in house; and that the regulators also need to reach out to outside consultants, consumer groups, and officials in other state agencies.
Thanks in part to provisions in the Patient Protection and Affordable Care Act of 2010 (PPACA) and other federal laws, the U.S. Department of Health and Human Services has been working to strengthen overall LTC quality monitoring and reporting efforts.
Genworth Financial Services Inc., Richmond, Va. (NYSE:GNW), recently made a point of working with AARP, Washington, to offer AARP members access to a database that includes LTC provider performance ratings.
People seem to be more interested in LTC quality these days because many boomers are shopping for care for their parents, and some are having to look for care for themselves.
The new interest in LTC services quality is coming, of course, at a time when no one has any money, and the providers are under pressure to scrimp and skimp to stay in business.
The trends raise the question: Once the private LTCI industry gets out of its current morass, will LTCI carriers, or brokers, or affiliates, play a bigger role in ensuring that policyholders get high-quality care as well as having the money to pay for care?
LTCI carriers already promote their ability to put families in touch with geriatric care managers.
Users of medical and dental managed care networks stay in-network partly because they're hoping the network managers have weeded out the providers with diplomas from the School of Adobe Photoshop.
Maybe, in a few years, LTCI carriers will play a more active role in determining whether an LTC provider is up to snuff, or, in some cases, helping the LTC providers improve their performance.