White Papers and Case Studies

Shared Platform Approach Most Effective Way to Manage MLTSS

August 15, 2016| Payer, Provider, White Paper

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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Americare Scales its Business After Implementing HHAeXchange’s Shared Platform Solutions

July 5, 2016| Case Study, Payer, Provider

A Case Study with Americare Companies’ CIO, Michael Mayer

When Michael Mayer, Chief Information Officer with Americare, joined the organization, the company was managing clients and employees with both paper and an older software system for the Licensed Agency. These systems required a tremendous amount of manual intervention which was both labor-intensive and inefficient.  As an organization that not only provides short term care themselves, they also have a large network of contracted providers to deliver long term home care services. Because of this, they act as a payer, case manager, and provider. Americare’s environment is further complicated by the fact that additional programming logic is necessary because the episodic payment requirements for Medicaid differ from that of Medicare.

In order to provide the best patient care and stay competitive within the marketplace, Mayer and the executive team recognized the need to strengthen its visibility and oversight to the delivery of services by agencies within the network. Their strategy included enterprise-wide improvements in the key areas of clinical and operational automation, home care visit verification and claims management. Mayer and the Compliance team saw this strategy as the most expeditious way to prevent fraud, waste and abuse (FWA) and drive more profits into the business. What they didn’t realize was the additional tangential benefits this key initiative provided to the organization, the provider network and the patients being serviced.

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Testimonials

I've been managing and submitting my claims via HHA eXchange and I have one word....fantastic! My billing time has been cut drastically. I better control my visits and employees, but work less at it. It is so much easier to stay in compliance with HHA eXchange… thanks Homecare Software Solutions!

Berey Weiss, Greater NY Homecare

Our experiences using the HHA eXchange program have been very positive. Their compliance toolset is excellent, and really gives us confidence that we are billing as near error-free as possible. It has greatly decreased unnecessary workload. It all just flows and is extremely user-friendly. My staff is extremely happy with it.

Susan Katz, Summit Home Health Care