For many William & Mary students, the first weekend of the Spring 2020 semester meant easing back into the routine of campus life after the winter break. But for nearly two dozen William & Mary students, that first Friday afternoon was the start of a deep dive into one of the most serious challenges facing the U.S. and other aging societies: How do individual families and the country as a whole pay for the long-term care that so many aged and disabled persons need?
This question was the focus of a new one-credit course co-sponsored by the Boehly Center for Excellence in Finance and the Schroeder Center for Health Policy. The course, entitled “Private and Public Financing of Long-term Care,” was jointly offered by the W&M Public Policy program and the Mason School of Business. Over the course of three weekends, W&M students heard from a range of experts from private industry and the public policy sphere.
The course started with a discussion of the provision of long-term care services and supports (LTSS) led by guest speaker Dr. Christine Jensen, Director of Health Services Research with the Riverside Center for Excellence in Aging and Lifelong Health. Dr. Jensen described the services and supports individuals need while dealing with chronic disease and functional limitations. In addition, she described two important populations -- the recipients of LTSS and the individuals who provide those services informally (unpaid) to their loved ones. Her talk introduced the class to the human face of the problem the students would soon address – the challenges of private and public financing for long-term care.
On the first Saturday of the course, industry experts led students through the topic of private financing. First up was Ben Sadtler ‘12, a Financial Advisor at Gore Capital Management. Mr. Sadtler laid out the financing options available, ranging from self-insurance to various types of long-term care (LTC) insurance products. Then the students heard from Loida Abraham and Scott Goodman, both actuaries from Genworth Financial. Ms. Abraham shared her firsthand knowledge of the development and evolution of long-term care insurance, while Mr. Goodman detailed the sources of financial pressure of private insurers. The private session wrapped up with a presentation of the future of the LTC insurance industry, including emerging alternatives to traditional products.
The following Saturday it was time to learn about the challenges affecting the biggest payer of long-term care in the U.S. – the Medicaid program. Dr. Lou Rossiter, former Secretary of Health and Human Resources in the Commonwealth, shared his expertise while working in the public sector. As Secretary, he was responsible for 13 state agencies, including the Department of Medical Assistance Services (DMAS) the agency that administers Medicaid. Dr. Rossiter spoke about trends in Medicaid LTSS spending, the impacts of LTSS spending on states and the federal government, and options for states to contain costs. Next, Rusty Walker ’05, Director of Value-Based Purchasing at Virginia’s DMAS, described how various states, including Virginia, are looking to private managed care plans to deliver Medicaid LTSS in a more cost-effective manner. He described the goals of “managed LTSS” and the ways states can use incentives, such as capitation rates and bonuses, to reduce costs and improve quality. Later that afternoon, students heard from Dr. Christine Eibner, ’95, who directs the Payment Cost and Coverage program at RAND Corporation. Dr. Eibner spoke about the proposed changes to the Medicare’s coverage of LTSS in several single-payer proposals introduced in Congress.
Finally, students had the opportunity to work on their vision of long-term care. Working individually, and then in teams, students developed their pitch for how to solve the long-term care financing problem. On the last day of class, students made their pitches to a panel of three judges – their course instructors, Professors Carl Tack (W&M ‘78) and Jennifer Mellor, plus guest judge Dr. Christine Jensen. Teams pitched ideas ranging from new marketing proposals for LTCI products, new incentives for care workers, and changes to the Medicaid program. The winning team pitched a series of changes to Medicare to provide more generous coverage for LTSS.
“We really hope that this course will stimulate some of the students to explore these topics in more detail, as part of their future studies or even as part of future careers,” said Carl Tack, who co-taught the course. Student Olivia Coan, ’21, suggests that this goal was realized. “I’m so glad I was able to hear from so many intelligent and experienced industry professionals, especially as I consider where in the healthcare industry I would like to build a career.”