Increasingly, the people who use Long Term Services and Supports (LTSS) get their healthcare benefits through managed Medicaid plans. This population has distinctive needs, and the plans are working hard to identify and adopt new ways to address them.
A recent AHIP webinar brought together healthcare experts to discuss LTSS needs, how well the plans are responding, and best practices to improve health outcomes. The roundtable included:
- John Driscoll, CareCentrix CEO
- AnneBeth Litt, CareCentrix Medicaid Medical Director
- Linda Hines, Virginia Premier Health Plan Medicaid Plan President
- Mike Nardone, Health Policy Consultant
- Susan Tucker, Health Management Associates Principal, and
- Scott Markovich, CareSource EVP of Markets & Products
Here are highlights from their conversation:
Challenges to Managing the LTSS Population
Medicaid plans can optimize services for their LTSS beneficiaries once they understand how their needs differ from their general Medicaid population. Linda Hines noted that, on average, LTSS beneficiaries have at least four chronic conditions, are prescribed at least six medications, and are more likely to have behavioral health and social challenges than the general Medicaid population.
Health plans can use this knowledge to inform their care approaches. For example, they may need to devote extra resources to addressing social determinants and care coordination.
Best Practices to Promote LTSS Population Health
The panel identified several best practices that health plans can implement to improve outcomes. For example, care management programs should consider the whole person rather than merely the “diagnosis.” That means addressing social determinants of health as well as physical and behavioral health needs. Because individuals who receive LTSS are more likely to encounter social or behavioral difficulties, the best way to address an individual’s unique needs is to proactively develop a person-centered care plan.
Dr. Litt shared the example of helping someone with diabetes manage their diet. A traditional approach might begin and end with giving the individual information about healthy diets. However, with a person-centered approach, we might learn that the individual can’t access transportation to visit a full-service grocery store or perhaps doesn’t have a kitchen to store and prepare food. By considering factors like these, health plans, healthcare providers, and community organizations can intervene to help people access the resources they need to maintain and improve their health.
LTSS Coordination is Key
Because health plans need to consider so many elements when managing individuals receiving LTSS, care coordination plays a crucial role in achieving positive outcomes. Health plans that care for LTSS populations often engage community service organizations to help address food or housing insecurity—which in turn creates the need to align these organizations with the healthcare providers and family caregivers.
Scott Markovich pointed out the importance of a “quarterback” to coordinate and manage the various providers who deliver an individual’s services. A quarterback can be particularly helpful in managing care transitions because individuals receiving LTSS are at particular risk of inadvertently losing specific services in the move from one facility or care site to another. Another way to mitigate this problem is to minimize the number of care transitions in the first place. Frustratingly, delaying transitions can also create problems of their own; Linda Hines said that “the longer someone is in a nursing home, [the more] their support system in the community dries up, and it becomes harder to transition them back into the community.”
New Ways to be Proactive
Ideally, Hines added, we can eliminate many of these nursing home stays by being more proactive in identifying member needs and addressing them before they require nursing-home care. Plans can take this proactive approach via predictive analytics that considers clinical, psycho-social, and home environment needs. John Driscoll agreed, noting that “there’s a lot of value in bringing in technology for this prediction element.” The resulting analysis can be used to deliver deeply personalized recommendations, generate care plans with the quickest and safest path home for each member, and optimize services in the home and community.
With predictive analytics, we can conduct more targeted outreach to ensure individuals have the services they need and are adhering to their care plans. This could include digital remote monitoring of chronic conditions in real-time to prevent avoidable emergency department visits and acute admissions that typically result in discharge to facility-based care. With these tools, we can not only help individuals get home faster, but help them stay home longer.
Opportunities Looking Ahead
There are many reasons to be optimistic about the care of individuals who require LTSS. “There have been a lot of changes recently that are moving us in the right direction,” Scott Markovich said. For example, he mentioned that social determinants are increasingly recognized as a crucial factor in keeping this population healthy. He also discussed the increase in “data and new tools that can help us manage these individuals in the future and aid in a person-centered approach to care.
In closing the session, John Driscoll noted that care plans can’t delay addressing these complex and interconnected issues. “This population is coming [for managed Medicaid plans],” he said. “You’re going to be managing the most vulnerable populations.”
As these plans begin caring for individuals who require LTSS, they will need guidance to make the most of the tools now available to help them. “We at CareCentrix are poised to help ensure the LTSS population has the care and coordination they need to stay healthy at home,” said Driscoll.
You can view the full AHIP webinar here to learn more.