How Medicaid Payers can achieve greater visibility with consumer directed services

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  • July 24, 2017

In the United States, Consumer Directed Services (CDS) continues to grow as states prepare to address a looming shortage of home care workers. A recently proposed bill calls for reimbursement increases for personal support (11 percent) and self-directed services, as well as an increase for some home aide and registered nurse services (14 percent). In other countries, CDS is even becoming more prevalent. For example, Australia recently rolled out a Consumer Directed Care program that provides members more control over the types of care and services they access and the delivery of those services, including who delivers the services and when.

While CDS has its benefits to the home care industry as a whole, it complicates payer processes. The standards for aide accountability & compliance policies are still evolving and visibility into quality of care can be limited, making it difficult for payers to gain insight into:

  • Completion of scheduled home visits
  • Adherence to the plan of care
  • Hours delivered as authorized
  • Billing accuracy

Even tracking hospital re-admissions can be difficult through CDS, as managed care organizations and state Medicaid programs have very little insight into member care and treatment. It also opens up even more opportunity for fraud, waste and abuse, as current systems have limited opportunity to track or monitor the care that’s being delivered.

With more than 80 percent of states permitting or requiring self-directed care in at least one Medicaid program, payers must find a way to gain additional insight into this type of care, especially as the number of states allowing individuals to use self-directed services continues to grow. Technology with a centralized, “real time” shared view between payers and CDS providers that integrates with existing systems will allow payers the oversight required to ensure that care and billing reported is completely accurate.

CDS is a challenging area for Medicaid payers, but leveraging a technology platform that requires more communication and provides more transparency and visibility can help ensure that the right member care is being delivered.

Learn more about increasing visibility with the integrated HHAeXchange Payer Management Solution.