Key Components for Successful LTSS Integration: Lessons from Five Exemplar Plans

Jennifer Windh
G. Lawrence Atkins
Lois Simon
Leah Smith
Anne Tumlinson
April 2016

LTSS can improve quality of life for individuals with multiple chronic conditions and functional limitations. This resource consists of five case studies of geographically diverse, exemplar LTSS programs in the United States, along with a taxonomy of elements of an LTSS program that is fully integrated into medical care.

  • The most important activities in an integrated program are anticipating needs and providing support in the home and community; arranging for supports and services, such as housing and medication management; eliminating silos and having a single point of accountability, such as one care manager; and supporting members through transitions of care.
  • The resource also analyzes factors that influence variation in LTSS programs, such as state Medicaid requirements and the culture of the parent organization.
Posted to The Playbook on
Population Addressed
Adults Under 65 with Disabilities
Frail Older Adults
People with Multiple Chronic Conditions
People with Behavioral Health and Social Needs
Key Questions Answered
  • How can my organization design a program that integrates medical care with long-term services and supports (LTSS)?
  • What have other organizations done?
Level of Evidence
What does this mean?