An Assessment of State-Led Reform of Long-Term Services and Supports

In the Journal of Health Politics, Policy and Law, Mary Naylor and colleagues evaluate the strategies used by state governments to improve long-term services and supports (LTSS) for adults with disabilities and functionally impaired older adults. Three strategies have been most commonly pursued by state governments to improve LTSS: expanding noninstitutioal care, integrating payment and care delivery, and realigning incentives through market-based reforms. Naylor and colleagues evaluate these strategies based on nine dimensions, including: ease of access, quality of care/life, effective transitions among providers and across settings, reductions in racial/ethnic disparities, and cost-effectiveness. While each strategy has its benefits and drawbacks, the researchers find the limited breadth of existing evidence precludes an assessment of the impact of each strategy across all nine dimensions. The authors demonstrate the interdependent and complex nature of the LTSS delivery system, suggesting policy makers will need to develop a multipronged strategy that incorporates a range of services to meet the complex needs of a population of adults with disabilities and/or functional impairment.