VNS CHOICE, an innovative managed long term care demonstration program sponsored by the Visiting Nurse Service of New York, suggests the potential of home care organizations to become insurers for managing home, community and institutional-based long term care services while coordinating medical care as a non-covered service. It is financed through risk-adjusted monthly capitation payments and is at full risk for all covered services.
The program, the first and largest of its kind, began serving frail elders in 1998 and achieved a census of over 2,600 members in three years. Typically, VNS CHOICE serves individuals who are more medically complex and functionally compromised than other contemporary managed care programs. The average VNS CHOICE member is 79 years old, needs assistance with three activities of daily living, has five chronic medical conditions, takes eight medications, and lives alone. One-third are cognitively impaired, and 99% use assistive devices.
Program organizing principles are home care as the hub of service delivery, team-based service model, community-based network, focus on maximizing function and independence, member choice, scale and ability to facilitate geographic expansion, and replicability. Measures of success include census growth, low disenrollment, member satisfaction, financial performance, staff satisfaction, network growth and capacity.
Learning Objectives: At the end of this session, participants will be able to: 1. Identify innovative elements of the VNS CHOICE model of managed long term care and compare this program with other models. 2. Use case studies to describe how the program coordinates covered and noncovered services. 3. Identify organizing principles, key accomplishments and lessons learned in the three years of program operations.
Keywords: Frail Elderly, Home Care
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: VNS CHOICE
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: Ms. Fisher is Vice President and Executive Director of the VNS CHOICE program.