As the healthcare industry continues its evolution from fee-for-service to value-based care models, payers need to keep pace with rapidly changing (and widely varied) statewide requirements. One of the big changes happening now is a shift of LTSS (long-term services & supports) programs to managed models, called an MLTSS program.
According to the Center for Health Care Strategies, more and more US states are adopting Medicaid MLTSS programs. They are being rolled out as a way to ease transitions from institutional to home-based care while also delivering better quality care and managing costs. As of 2021, there were already 24 states running MLTSS programs, up 3X since 2004.
The obvious implication is that the other 26 states likely aren’t far behind. In fact, Indiana has an open MLTSS RFP at the time of this writing. This means that Medicaid payers need to at least be planning for MLTSS programs if they aren’t already running at least one. And as you’re adapting to the changing requirements of your state (or states), you’ll need the right care management software to help your bids stand out from the crowd.
Why States Are Shifting to MLTSS
The common challenges that states are trying to address by moving to an MLTSS model include:
- High-quality person-centered care
- To meet a growing desire of residents to age and/or be treated in their own home, rather than in a hospital, nursing home, assisted living, or other institution
- To make sure that residents have quick, consistent, and easy access to HCBS (home & community-based services)
- To provide the highest quality of care for residents while also improving their AARP rankings
- To link provider payments to member outcomes, the foundational tenet of the value-based care model
- Cost & logistics
- To keep pace as populations age: the number of US citizens aged 65 and above is expected to nearly double by 2060
- To address data quality and reporting issues, including ensuring that states receive accurate and timely information from providers
- To achieve cost sustainability over the long term, particularly as LTSS populations represent a larger-than-proportional share of total Medicaid spend
- To meet SLAs and quality metrics around hospitalizations and transitions of care
Medicaid payers are being charged with helping states achieve these goals. The good news is that you don’t have to do it alone: the right care management technology will help check all of these boxes, and more. Let’s take a look at what you should expect to gain from a care management platform that’s designed for MLTSS.
How Can Technology Help?
Care management platforms unify care teams around each individual member for more efficient treatment and services that lead to better outcomes. The technology also creates efficiencies and automates common tasks, letting care teams focus on what matters most – people, not administration.
When it comes to supporting members enrolled in MLTSS, the right care management software can make a huge difference.
- It puts people at the center of care. The right technology enables person-centered care by streamlining or stripping away administrative duties, leaving care teams with more time to spend with their patients. It also uses AI (artificial intelligence) to surface the right tasks at the right time, based on each individual’s history. This gives care managers greater confidence in their clinical decision-making.
- It connects people to their communities. HCBS (home & community-based services) access is a major requirement of any MLTSS program. The right software will connect care managers with needed community resources such as transportation or food pantries, and then confirm once the service has been delivered.
- It shares data across the care network. Care management software links members, providers, facilities, and state bureaus together on a single source of truth. This provides real-time data collection, validation, and distribution, plus clear reporting functionality for all stakeholders.
- It enables value-based purchasing. As we mentioned, the core of value-based care moves provider payments away from the traditional fee-for-service model, instead of tying payments to member outcomes. This makes providers accountable and focused on results, not activity. With a care management platform, it’s easy to connect the dots between a member’s service history and their health outcomes.
What To Look for in Care Management Tech
When it comes to choosing a care management platform for your MLTSS program (or for your bid to win an MLTSS RFP), here are the key capabilities to look for:
- AI-driven automations, trigger-based prompts and reminders, configurable assessments and value sets, data validation, task assignments, and more
- Seamless integrations with community SDoH resources plus closed-loop reporting when services are delivered for full accountability
- Flexibility to scale as the US population ages and more members become eligible
- Customizable billing matrices that can be built into service plans
- A cloud-based model that delivers higher lifetime value and faster ROI
- A highly configurable build that can be customized without lots of IT support
- A simple, intuitive user interface that is easy to learn
- Complex care pathways that are based on industry best practices
- The ability to support MLTSS in multiple markets with varying regulations and requirements
The right care management platform can even improve employee satisfaction, avoiding burnout and making it easier to retain your workforce. This is particularly critical among high-turnover roles such as service coordinators.
If you could use a little help in sourcing the right care management solution for your organization, check out: Care Management Platforms for Medicare & Medicaid Payers: 11 Questions to Ask.
