Long-term services and supports (LTSS) managed care organizations (MCOs) play a critical role in helping states fulfill their Medicaid responsibilities to society’s most vulnerable members. And right now, the need is even greater. With budget shortfalls, growing enrollment, and the COVID-19 pandemic creating the perfect storm, states are looking to LTSS MCOs for a path forward through innovation.
Aligning with the shift toward value-based care, here are eight ways LTSS MCOs can ensure better care for members while reducing costs.
#1 – Improve Care Coordination – Collaboration between LTSS MCOs, providers, payers, and members is essential to ensuring value-based care. Prioritize communication initiatives amongst your partners and invest in technology to generate workflow efficiencies, enable data sharing, and most importantly, break down silos.
#2 – Enhance Homecare Network Performance – With better care coordination, LTSS MCOs have access to more information — such as a patient’s data across all homecare provider networks. Use this visibility to make real-time improvements and help care teams see how they measure up against goals.
#3 – Strengthen Homecare Provider Networks – An LTSS MCO’s efforts to recruit and maintain their homecare provider networks is crucial to ensuring access to necessary care. LTSS MCOs can address this with direct outreach, financial incentives, automatic case broadcasting to match members to providers, and prompt payment policies.
#4 – Embrace Electronic Visit Verification (EVV) – EVV ensures timely service delivery for members and prevents fraud, waste, and abuse (FWA). Set your homecare network up for success by encouraging the use of convenient, easy-to-use EVV platforms, and be sure to address their concerns proactively.
#5 – Build Social Determinants of Health (SDOH) Referral Programs – While most health plans now have SDOH screening protocols, the next step is to create a referral system with community-based organizations to meet member needs. This will ultimately have the greatest impact, as 80-90 percent of a patient’s outcomes can be attributed to SDOH.
#6 – Expand High-Risk Care Management – In addition to helping patients with chronic illnesses, this approach can also benefit those with negative SDOH or a history of substance abuse. High-touch coordination has the greatest potential to reduce costs. For example, Medicaid members diagnosed with opioid dependence have medical costs almost three times that of patients without the diagnosis.
#7 – Focus on Member Engagement – LTSS MCOs must effectively motivate members to complete activities that improve health outcomes. Influence your members’ behavior by deeply understanding the populations you serve, offering incentives they value, using mobile technology, and creating community partnerships.
#8 – Explore Self-Direction – For LTSS MCOs, self-directing members can strategically use their budget to gain the most benefit, which usually translates into cost savings and better care. In addition, the ability to hire friends or family members addresses the shortage of caregivers, which was exacerbated by COVID-19.
The bottom line is — value-based care models are here to stay. Any LTSS MCO strategies that put patients at the center of their decision-making process will be moving in the right direction. Whether that means understanding a member’s SDOH, seeing data holistically, engaging with them personally, or giving them more control over their healthcare, the future of care is patient-centric.
Developed specifically for the Medicaid patient population, HHAeXchange is the leading technology platform for homecare and self-direction program management. To see how we can help you ensure better care for your members and reduce costs, contact us.