VH Insights

LTSS & Coordinated Care Management
February 28, 2022

What is LTSS & How Can Care Coordination Technology Improve Outcomes?

What is LTSS?

LTSS, short for long-term services and supports, is an umbrella term for a wide range of medical and personal care services for people who struggle to look after themselves due to long-term conditions. LTSS patients span all ages and backgrounds and live with a variety of challenges such as:

  • Aging-related conditions, such as Alzheimer’s or Dementia
  • Intellectual or developmental disabilities (IDDs), including Down Syndrome or cerebral palsy
  • Physical disabilities

How Do LTSS Members Receive Care?

LTSS care is offered through many different settings, from care facilities to the home. Historically, LTSS treatment was given almost exclusively in institutional settings such as psychiatric hospitals, nursing homes, or care facilities for individuals with IDDs. However, in the last two decades, patients have been increasingly receiving LTSS care at home through home and community-based services (HCBS). HCBS are often preferred because they allow the patients to receive care while remaining in their communities to “age-in-place,” but take the pressure off family members who would otherwise be primary caregivers to support their loved ones at home. HCBS can help close gaps by assisting patients with their medical needs as well as personal care for their activities of daily living (ADL). Via attendant services, HCBS can assist with:

  • Hygiene upkeep (bathing, grooming)
  • Cooking
  • Housekeeping
  • Transportation

Those who cannot safely live independently reside in assisted living facilities, where care is provided for adults who need some supervision, but not 24-hour nursing care. Residents live in their own apartments with varying levels of assistance and receive help with daily homemaking tasks such as cooking, laundry, and housekeeping. LTSS support regardless of setting is robust and often lasts for years or even decades depending on the challenges in question. 

Coordinated Care: Empowering Populations to Age-in-Place

Most LTSS patients are Medicaid recipients, which covers LTSS needs within institutions and individual homes. LTSS populations are some of the costliest individuals for Medicaid to cover, with total spending in this area topping off at $182.8 billion in 2019. In an attempt to reduce costs and provide better care for their most high-needs populations, CMS has approved both federal and state-level managed care programs, called managed long-term services and supports (MLTSS) care organizations, to provide coordinated care for LTSS members. Additionally, there is increasing pressure to align MLTSS with Medicare-managed care plans in order to better address the Duals populations’ needs. LTSS populations, in particular, benefit from coordinated care (and coordinated benefits) because their health challenges are often chronic and require numerous doctor visits, costly treatments, and other varied services across the healthcare ecosystem. When managing coordinated care, however, MLTSS providers not only require a winning strategy to keep costs down, but a modern technology solution that makes ingesting, analyzing, and leveraging data from multiple third-party sources. 

By centralizing patient medical health information, behavioral health details, and social factors, care management solutions like HELIOS® can put all of the most relevant data points in front of care teams, empowering them to make the most informed decisions possible. HELIOS® leverages intelligent rules engines and automated workflows to ensure that payers and providers can take the right action at the right time. With modern care management technology like HELIOS®, care teams can spend less time on administrative tasks and more time where it counts: caring for the LTSS members that need it most.

Choose HELIOS® for Centralized and Efficient Care

Individuals who struggle with long-term challenges–from the elderly to the intellectually disabled–are present and numerous in our communities, and deserve robust, specialized, and proactive care that allows them to remain as independent as possible. Medicaid and Medicare plans are currently trailblazing the future of LTSS with managed care approaches, but to make the most of these strategies, also requires a premium, digital platform to most effectively administer care. VirtualHealth’s HELIOS® has already demonstrated that its best-in-class solution can improve the quality of care while driving down costs for LTSS populations. With robust, holistic care delivered by MLTSS organizations and managed through HELIOS®, high-needs groups like LTSS populations can receive better care while keeping costs down.