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  Background:

Over the past decade, managed care has emerged as the dominant market force in the reshaping of our nation's health care system.In fact, most commercially insured working individuals in the state are now enrolled in some type of managed care system. It is expected this percentage of elder served by such care systems will continue to increase.The promise of managed care for frail and at-risk elders includes enhanced coordination and integration of care across providers, locations and time; increased emphasis on prevention and community-based care; and greater flexibility in the types of services, providers and settings available for care.However, much still remains to be learned regarding how best to structure systems of care for frail and at-risk elders. Questions include which services are most beneficial to which elders; the optimal times, providers, payers and places for these services; and most importantly, how to ensure quality care.
 

Program Structure:

+ enhance the autonomy, dignity and independence of elders in managed care through increased information, choice, and capacity for consumer direction;
+ involve partnerships among community-based service agencies, medical groups, integrated health systems, health plans, researchers, and/or others working together to find better ways to provide and coordinate services;
+ incorporate a broad view of health (including psychosocial issues, living arrangements and social support) beyond specific medical conditions; and
+ are comprehensive in scope and address the need for a full continuum of care

Our large and growing population of elders experiencing, or at risk of, functional decline poses substantial challenges for health plans and providers. While managed care organizations (e.g., health plans, medical groups, integrated health systems) have been relatively proficient in caring for healthier elders, only a few have developed strategies for coordinating and delivering a full range of health and supportive services to sick or at-risk elders. Even fewer have developed strategies for providing culturally appropriate services to rapidly growing racially and ethnically diverse elder population.

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