Indiana ranks as one of the worst states in the country for helping older people decide where they want to age – at home or in a nursing facility.
The Holcomb administration plans to overhaul its managed care system to provide older Hoosiers with better, easier and more affordable choices.
According to the state, recent surveys show 75 percent of Americans over age 50 want to remain in their own home as they age. But in Indiana, only 45 percent of Hoosiers eligible for Medicaid are actually doing so.
Consider this scenario: a 70-year-old grandma, living at home, breaks her hip. Under Indiana’s current system, it could take months for her and her children to learn if she’s eligible for home-based services, meaning she’s much more likely to end up in a nursing home, even if that’s not what she wants.
Indiana Family and Social Services Administration Chief Medical Officer Dr. Dan Rusyniak said the state wants to fix that.
“This new system gets home services faster, helps coordinate the care that’s needed and provides the supports that sustain it for both grandma and her family,” Rusyniak said.
Indiana will do that in part by speeding up the eligibility process and building up a workforce for home care. It will also provide more resources to family members who are caring for loved ones at home, like financial help and education.
FSSA Secretary Dr. Jennifer Sullivan said fixing the system is also about making it less disjointed.
"It means that transitions between hospital to home, to rehab to long-term care and back are actually coordinated in a central manner, rather than being fragmented and really difficult to navigate for families," Sullivan said.
The state has set four goals as it sets out to overhaul its managed care landscape: getting Hoosiers access to home- and community-based care within 72 hours; moving its long-term services and supports (which includes a whole spectrum of care for older Hoosiers) into a managed model; linking the payments health care providers receive to patient outcomes; and creating an integrated data system that connects all those care providers, patients, families and health care facilities with the state.
Rusyniak said the latter goal – integrated data – will help ensure Hoosiers are getting the care the state wants them to have, something that isn't possible right now.
"So, we can't look at someone and say, 'what are all the services they're getting and more importantly, what services are they not getting but should be,'" Rusyniak said. "Likewise, we can't easily compare providers to see who are the best and worst performers and we can't easily compare facilities on the outcomes we want to know about."
Fixing the system also goes beyond patient care and satisfaction; it's about saving money, too. Keeping someone in a nursing home costs the state (and often the patient and their family) considerably more than home-based services.
Sullivan and Rusyniak said the "gold standard" is Medicaid spending that goes 60 percent to home-care services and 40 percent to so-called "institutional" care. They wouldn't say exactly what Indiana's balance is right now – but in the last data the state made available, that ratio was flipped: 68 percent of Hoosier Medicaid spending for long-term services and supports went to institutional settings, while only 31 percent went to home-based care.
Sullivan said the state's current goal is a 50-50 split.
Officials say overhauling the system won’t happen overnight. But pilot programs are already underway.
There could be legislative hurdles, however. Indiana currently has a moratorium in state law that prevents additional spending through managed care providers (the private care providers that include insurers, hospitals and health care workers). That moratorium is set to end this year unless lawmakers renew it, which Sullivan said the Holcomb administration will ask the General Assembly not to do.