Several factors, including an aging population as well as successes in treating acute conditions and extending lives, have led to an increase in the number of Americans with chronic conditions. This development poses a significant challenge for both the health care system in general and for post-acute and long-term care systems in particular. Spending for post-acute and long-term care is high, and evidence about the quality of care remains uneven. Policymakers are keen to understand how to achieve higher-quality care at lower costs. Although the tendency has been to describe post-acute and long-term care services in terms of care settings--hospitals, skilled nursing or long-term care facilities, and community-based providers--individuals often receive care in more than one setting and often "bounce" among settings. In addition, some settings provide more than one type of care. As with other parts of the health care system, the organization and delivery of acute and chronic care services are evolving as payers and providers respond to new programs, new payment models, and market consolidation. As a result, consumers face new choices in managing their own care. This brief summarizes key points from a meeting convened by AcademyHealth in December 2016. Research and policy experts reviewed current strategies to improve care and lower costs for post-acute and chronic care, especially as related to the Medicare and Medicaid programs. They were asked to think about the implications of research findings related to current strategies and to consider opportunities for better meeting patient user needs in a cost-effective manner. Presenters described ongoing initiatives and potential opportunities to promote value-based payment reforms for post-acute and chronic care. They discussed innovations to enhance care and improve outcomes--including more effective care coordination, new information technologies, linking with social services, and strategies for better educating and engaging consumers. They also noted that successful implementation of new payment and care models requires sophisticated financial and management skills. Throughout the meeting, they stressed the need for improved quality measures with an emphasis on both outcomes and cost. Given that information about the efficacy of new and evolving payment and service delivery models will be limited in the near term, they called for more rigorous evaluations.
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