The Challenge

Optimize home and community based services for members who use Long Term Services and Support (LTSS) at home.

Individuals requiring LTSS make up only 6% of Medicaid enrollees, and account for 33% of total Medicaid spend ($182 B).1 Additionally, nearly 60% of costs for LTSS is attributed to Home and Community-Based Services (HCBS).2 These members are living with multiple chronic, complex conditions, and often need extra support to complete activities of daily living at home.

Enhance care for your LTSS members

Health plans are working to adopt and enhance capabilities to deliver person-directed healthcare, improve outcomes and reduce the total cost of care, but are faced with challenges, including:

  • Coordination of medical, behavioral and social services for whole-person care
  • Access to advanced analytics to identify and stratify high-risk and rising-risk members
  • Consistent allocation of appropriate HCBS, including with Personal Care Services
  • Reducing the frequent care transitions between hospital, sub-acute facility and the home
  • Integrating care for dually eligible members

Our Approach

Our LTSS Home and Community Connections combines HomeFirst Analytics, home-focused clinical solutions and digital engagement technologies to support LTSS members as they live safely and independently in their home and community. Components of the solution include:

  • Advanced predictive analytics that identify high-risk members and optimize HCBS, with a unique focus on PCS
  • Connect members to community services, facilitating in-home services including member and caregiver education, digital check-ins, and tracking member progress
  • Digital tools and condition-specific messaging that improve member and caregiver engagement and chronic condition management
  • Post-acute care management and readmissions programs that quickly rebalance care to the home and prevent costly, avoidable facility stays
  • Utilization Management to ensure optimal use of available benefits

The CareCentrix Value

Our LTSS solution reduces chronic condition exacerbations, unnecessary emergency department visits, and avoidable hospitalizations and readmissions while carefully managing HCBS and PCS. It may improve quality scores and member experience ratings, prevent avoidable acute events, and improve member and caregiver engagement, which can improve member quality of life.

The LTSS Home and Community Connections solution rebalances care to the home:

  • Optimizes PCS hour allotment to create savings while maintaining well status
  • Closes gaps in care to improve member outcomes while remaining in the home
  • Reduces unnecessary emergency department visits and readmissions through remote patient engagement technologies

Addressing Key Challenges to Managing LTSS