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NYAM Section on Health Care Delivery Presents Panel on Managing Long Term Care

 Joanne Cunningham, Michael Fassler, Mark Kator, and Bruce Vladeck

On June 3, 2013, NYAM’s Section on Health Care Delivery presented a panel discussion on the impact of New York State Medicaid reform on the long-term care sector. The event, “Managing Long Term Care,” marked the end of the section’s popular event series for the 2012-2013 season.

“Managing long-term care is a topic that has become increasingly important as we look and think about implementing health care reform in New York,” said Hila Richardson, Section Co-Chair.

The keynote speaker for the event was Bruce Vladeck, PhD, Senior Advisor to Nexera, who has 30 years of experience with long-term care. Dr. Vladeck spoke about New York State’s plan to increase the number of Medicaid Managed Long-Term Care plan enrollees from 40,000 to 370,000 over three years, per the recommendations of the state’s Medicaid Redesign Team. The stated goals are to improve quality and coordination of care and save money, but the state faces a number of challenges. For one, Dr. Vladeck said, “long-term care is profoundly unlike acute care—it’s all the things sick people need that doctors, nurses, and hospitals don’t want to provide or don’t know how to provide. Long-term care patients have serious and complicated medical and functional needs.”

Another major issue, Dr. Vladeck said, is that while community-based long-term care may save funds in some areas, it must be remembered that it “places a huge burden on the family” by externalizing major costs that are traditionally covered in hospital and nursing home settings, such as rent and food.

Dr. Vladeck also expressed concern that in order to meet its volume targets, the state is requiring existing plans to increase enrollments at an extraordinary rate. It is also recruiting new health care plans, many of which have no experience handling long-term care populations, at a time when there are limited state resources available for monitoring the plans and services.

A panel of experts then responded to Dr. Vladeck’s presentation and shared their own experiences with and concerns about managing long-term care in New York.

Joanne Cunningham, President of the Home Care Association of New York State, called the state’s plan “a dramatic, fast, and not always very well thought out plan to move such a big population to one model without a lot of resources.” She stressed the importance of making sure that this vulnerable patient population continues to get the services they need.

Michael Fassler, President and CEO of CenterLight Health System (formerly Beth Abraham Family of Health Services), there has been more change in the last three years than in the rest of his 35 years in the field. He emphasized the need to measure and reward quality in the provision of long-term care services.

Mark Kator, President and CEO of Isabella Geriatric Center, listed a number of actions that can be taken to improve this process: identify cost efficiencies by finding platforms for sharing costs and providing services through shared service agreements, tackle the issue of labor costs, focus on quality improvement and management, and develop metrics to measure outcomes against the expectations of both the managed care plans and the state.

“Developing partnerships is going to be essential; none of this care takes place in one place,” Mr. Kator said. 

“We are dealing with a historically unprecedented phenomenon—never in human history has there been such a large number of older adults,” Dr. Vladeck said in closing, highlighting the importance of understanding this population’s novel set of issues and problems as New York moves forward with its goal of providing quality long-term care to its residents.

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Posted on June 7, 2013

Gina Ravosa
Director of Marketing & Communications
The New York Academy of Medicine
1216 Fifth Avenue
New York, NY 10029
(212) 822-7285


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