White Papers

Shared Platform Approach Most Effective Way to Manage MLTSS

Real-time Oversight and Connectivity Needed to Reduce MLTSS Risk for Medicaid Payers, Home Care Providers

Rapidly shifting market forces have strained the delivery of Managed Long Term Services and Supports (MLTSS) in the United States to the point where spending may continue to outpace inflation, even as demand increases. Budget-strapped Medicaid payers, including state Medicaid programs and managed care organizations, must deliver high quality outcomes and hold the line on increased expenses. New Medicaid members flooding into the system without standard treatment protocols and a scalable infrastructure create gaps in quality and multimillion-dollar vulnerabilities related to fraud, waste and abuse. MLTSS requires a different approach to remain sustainable – a technology enabled ecosystem of care coordination, case management and billing where Medicaid payers and home care providers work together throughout the entire spectrum of home care delivery. This includes, but is not limited to, referrals and authorizations, plans of care, scheduling, caregiver compliance, visit verification and claims submission. Automation must be deployed and centralized to improve timeliness and service delivery at reduced cost. This white paper demonstrates how a shared platform approach will reduce MLTSS risk and improve operational efficiencies so Medicaid payers and home care agency providers aren’t left behind.

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