The discussions on the best case scenario for Medicare (minimizing the potential reductions), the huge challenges we will potentially experience with the new version of the MDS, and the budget projections for the Medicaid program were enough to send most attendees in search of lighter topics and potential savings from vendors. I prefer to dress up some of these challenges as opportunities: The time is ripe for non-traditional partnerships and for widening the difficult discussions about who should pay for the services nobody wants but most everyone will need. 

There are several parallel efforts that have been underway in Minnesota that are now entering the next stage of discussion and which, we hope, will keep moving forward -- even as we watch the national health care reform debate very carefully for any nuggets of long-term care financing opportunities. Although it has been frustratingly slow-going with both of these efforts, the fact that they are occurring at all should give us pause to celebrate, a bit. 

First, the Minnesota Chamber of Commerce established a LTC task force under the Health Policy Committee umbrella. I have been participating in meetings to establish a formal position paper on long term care financing—the first such paper developed by a state Chamber of Commerce. It will be presented to the Health Policy Committee this month, then the Chamber Board next month. While yet to be formally “blessed,” I wanted to at least share their draft reform principles from their position paper:

The MN Chamber of Commerce supports a comprehensive LTC solution that meets the following criteria:

Encourage individuals to be personally responsible for planning and saving for their long-term care needs and target limited public dollars to those that can least afford their own care.

Encourage greater participation and information sharing in the business community. Employers can help provide information for their employees to choose financing options and plan ahead for their long-term care needs.

Encourage innovative and flexible LTC solutions that will help promote the most cost effective delivery of LTC services and help reduce more costly care delivery mechanisms.

Secondly, the Citizen’s League has been working on their own version of long-term care financing, thanks in part to the contributions of many interested organizations. I serve on their Steering Committee, which just recently met to review the results of three workshops that met last month on informal care, health and medical choices, and financial behaviors. The end product of the workshops was a list of potential tasks to address these strategies:

1. Make it easier and more rewarding to provide informal care.

2. Make it easier for people to exercise more control over their health, medical conditions, and health care options.

3. Design and implement a 3-part financing plan for Minnesota that provides personal security as well as fiscal stability for Minnesota.

The Steering Committee worked to assess which of the ideas were likely to be the highest leverage ideas—that is, which would have a big impact if implemented and which involve systems/choices/behaviors that are easiest to influence. The ideas that came to the top and the relative preferences were:

1. Outreach campaign on LTC financing

2. Design of a LTC financing plan for Minnesota

3. Working with employers as an access point on a variety of LTC policies (e.g., leave for caregivers, LTC insurance education and tax benefits, retirement planning, etc.)

The next steps for this project are to move into the specific design of a financing plan --to include Medicare/Medicaid waiver request for a pilot project, at the same time working with other partners on an outreach campaign to make this a “tier one” issue for policy-makers. Again, the process seems slow to those of us who have been involved in this debate for centuries, but the expansion of new players (insurance companies and citizen advocates, for example) and a new expansionary process may just advance us a few more steps.