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Unintended consequences of steps to cut readmissions and reform payment may threaten care of vulnerable older adults.

Publication ,  Journal Article
Naylor, MD; Kurtzman, ET; Grabowski, DC; Harrington, C; McClellan, M; Reinhard, SC
Published in: Health affairs (Project Hope)
July 2012

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. We analyzed 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. We found that these provisions inadequately address the unique needs of vulnerable subgroup members who require long-term services and supports and, in some instances, could produce unintended consequences that would contribute to avoidable poor outcomes. We recommend that policy makers 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.

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Published In

Health affairs (Project Hope)

DOI

EISSN

1544-5208

ISSN

0278-2715

Publication Date

July 2012

Volume

31

Issue

7

Start / End Page

1623 / 1632

Related Subject Headings

  • Vulnerable Populations
  • United States
  • Reimbursement Mechanisms
  • Pilot Projects
  • Patient Readmission
  • Humans
  • Health Policy & Services
  • Health Policy
  • Health Care Reform
  • Delivery of Health Care, Integrated
 

Citation

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Naylor, M. D., Kurtzman, E. T., Grabowski, D. C., Harrington, C., McClellan, M., & Reinhard, S. C. (2012). Unintended consequences of steps to cut readmissions and reform payment may threaten care of vulnerable older adults. Health Affairs (Project Hope), 31(7), 1623–1632. https://doi.org/10.1377/hlthaff.2012.0110
Naylor, Mary D., Ellen T. Kurtzman, David C. Grabowski, Charlene Harrington, Mark McClellan, and Susan C. Reinhard. “Unintended consequences of steps to cut readmissions and reform payment may threaten care of vulnerable older adults.Health Affairs (Project Hope) 31, no. 7 (July 2012): 1623–32. https://doi.org/10.1377/hlthaff.2012.0110.
Naylor MD, Kurtzman ET, Grabowski DC, Harrington C, McClellan M, Reinhard SC. Unintended consequences of steps to cut readmissions and reform payment may threaten care of vulnerable older adults. Health affairs (Project Hope). 2012 Jul;31(7):1623–32.
Naylor, Mary D., et al. “Unintended consequences of steps to cut readmissions and reform payment may threaten care of vulnerable older adults.Health Affairs (Project Hope), vol. 31, no. 7, July 2012, pp. 1623–32. Epmc, doi:10.1377/hlthaff.2012.0110.
Naylor MD, Kurtzman ET, Grabowski DC, Harrington C, McClellan M, Reinhard SC. Unintended consequences of steps to cut readmissions and reform payment may threaten care of vulnerable older adults. Health affairs (Project Hope). 2012 Jul;31(7):1623–1632.

Published In

Health affairs (Project Hope)

DOI

EISSN

1544-5208

ISSN

0278-2715

Publication Date

July 2012

Volume

31

Issue

7

Start / End Page

1623 / 1632

Related Subject Headings

  • Vulnerable Populations
  • United States
  • Reimbursement Mechanisms
  • Pilot Projects
  • Patient Readmission
  • Humans
  • Health Policy & Services
  • Health Policy
  • Health Care Reform
  • Delivery of Health Care, Integrated