4.5 How will a MediCaring Community integrate LTSS and medical services for the local system?

First, the MediCaring Community governance will assure that frail elderly using a MediCaring service initiative will all have a person-driven care plan that includes supportive services as well as medical care. MediCaring does not envision that the local management entity has to be a direct service provider; it could be a manager and a revenue manager for the existing (and gradually improving) array of direct service providers. However, the MediCaring Community will certainly serve as a convener of providers and representatives of consumer interests for the geographic area.

The MediCaring Community will attend to infrastructure issues such as the effectiveness and scope of the Health Information Exchange, which should carry care plans, assessments, and evaluations and make them available to appropriate service providers. To do this, the Health Information Exchange vehicles will have to incorporate information from LTSS and provide information to LTSS providers. This entails careful planning when the work involves entities not covered by the Health Insurance Portability and Accountability Act (HIPAA) and with providers that do not ordinarily work with secure information exchange.[152]

As was explained in Chapter 2, the aggregation of elements of the care plans provides a remarkable tool for estimating service supply and identifying gaps. If the care plans annotate compromises due to service supply or quality, then the MediCaring Community’s managers will have that direct evidence as to gaps that are affecting care plans.

The MediCaring Community will manage the ongoing measurement of the system performance, though a contractor or another existing entity could provide the actual data collection and analyses. Those metrics will help forge relationships, since good outcomes for this population routinely entail cooperation among multiple provider types. The key metrics will be in public on dashboards and will be of concern to civic leaders and news media—again, a force for encouraging high performance.

Of course, the MediCaring Community will also be a major convener and a vehicle for building relationships, a function which will be enhanced by having the role of providing some revenues to address serious gaps in the service array. This will engage the public as well as the various provider organizations and will provide a creative disruption in the status quo regarding power and influence.

Neighbors could provide critical support for frail elders’ needs, and it seems likely that a MediCaring Community will re-fashion neighborliness to be widely valued and volunteered. Keeping an increasingly frail elderly person in the community might well require having some neighbors who will do minor repairs, bring in food on bad days, check in to talk a bit and be sure things are okay, and notify the right people when something is going wrong. Our historic myth would hold that families should be taking care of their own, but families are small, dispersed, often dysfunctional, and having to work. Already, among women aged 75 and over, almost half (46%) live alone.[153] So, Senior Villages, a possible Caregiver Corps, and other ways to organize neighborliness will be an important component of the eldercare services.[154],[155],[156]

[152] (Health Insurance Portability and Accountability Act of 1996, Public Law 104-191 1996)

[153] (Administration on Aging, Administration for Community Living, A Profile of Older Americans 2014)

[154] (Village to Village Network n.d.)

[155] (National Care Corps Act of 2015, H.R.2668 2015)

[156] (Caregiver Corps Act of 2014, S.2842 2014)