I have just returned from the Global Ageing Network Conference held in Montreux, Switzerland. More than 1,000 attendees from across the world attended this biennial event. LeadingAge is a primary sponsor of the Global Ageing Conference, and I attended, along with a few of my fellow board members.
As in recent years, the Global Ageing Conference piggybacked on the host country’s annual meeting/conference – or as the Europeans call it, “Congress” (if only the actual U.S. Congress was so civil). Since the conference was in Switzerland, most of the keynote speakers spoke in their native language of either French or German, but like the United Nations, the interpreter in the headset saved the day. Breakout sessions were dual tracks, one in German, the other in English.
Despite the language barrier, it was a verifying experience for me. It verified that despite the many issues in the United States today, and despite our lack of adequate public funding for the chronic needs of older adults, we are the most innovative Western country – with one caveat: For those who can pay. Several presenters expressed a desire for more life plan-type communities in their countries, and I had conversations with individuals who wanted to visit Well•Spring communities and learn from our model. This is reassuring, and yet at the same time alarming.
Arguably, innovation is often spurred by the pursuit of a sizable return of capital investment (in the U.S., especially), which is well and good. But what about the millions of Americans who will not have sufficient financial resources to pay for the services they require? Answering that question leads us to admit that innovation in this realm is sorely lacking amongst today’s policy makers.
Many states have either moved to, or are planning to move to, “managed care” programs for those enrolled in their state’s Medicaid program. This has been referred to as an innovative practice, and in theory it certainly is. Individualizing and customizing care to achieve desired outcomes can be a “win-win.” It serves the older adult by seeing that their desires are met, and in most instances, it can alleviate unnecessary and expensive care tactics which decrease the overall cost of care.
My worry though is that this “innovative” model becomes entangled in the pursuit of the return.
In North Carolina, the General Assembly voted to implement Medicaid managed care with a targeted implementation date of 2019. The legislation enacted allows for both provider-based managed care organizations and commercial or insurance company-based companies to operate Medicaid managed care programs. So, who do we think is going to “win” this business? Well-funded, highly capitalized insurance companies or providers? And if it is the former, what is their primary purpose for existence? Return of capital.
Please hear me out, I am not advocating for the socialization of chronic and long-term care in our country. Believe me, there will be enough demand for both forms of payment. However, if states incoherently believe that turning over their Medicaid programs to shareholder-led managed care organizations will improve long-term outcomes, I fear they are misled.
Yes, we are perhaps the most innovative country, but we can learn something, too, from our friends in other countries when it comes to caring for those unable to afford our “innovation.” It is a responsibility we will, collectively, shoulder sooner rather than later – I hope.