This is followed by a brief description of current end of life initiatives to improve care of the terminally ill. The next section summarizes discussions with hospice and nursing facility providers, federal and state certification surveyors, and state Medicaid officials regarding overlapping areas in caring for the terminally ill. Last, section 6 summarizes the issues and provides a framework for the four subsequent reports in this study. This report characterizes those nursing facility residents who enroll in the Medicare hospice program including when they enroll, how long they receive the benefit and how much other services they use. A subsequent report in this study compares the utilization and outcomes experienced by hospice and non-hospice nursing facility decedents who have been matched on a variety of criteria.
Most people receive their health insurance through employer-sponsored plans.
Yet little is known about the prevalence of chronic conditions and disabilities among plan enrollees. Similarly, employer-sponsored plans make extensive use of managed care, but little is known about the impact of managed care on those with severe chronic illness. This study was funded by the Office of Disability, Aging, and Long-Term Care Policy of the U.S. Department of Health and Human Services in order to better understand the role of private insurance plans in caring for people with chronic conditions and disabilities. It estimates the prevalence of chronic illness, analyzes the factors affecting the choice of indemnity plans versus managed care, and estimates the impact of managed care on service use and expenditures. The study also investigates the leading risk adjustment systems as a possible method for paying plans more appropriately in serving this population.