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Last week, I led a panel at the national conference on Home and Community Based Services focusing on the importance of consumer engagement in Medicaid managed care, and spoke at another session about the need to make managed care consumer-focused. While the challenges, opportunities and mechanics of managed care for long-term services and supports (LTSS) were the dominant theme of the conference, consumer voices were sparse among the hundreds of attendees. Yet, when I unveiled a checklist for making managed care consumer-focused, the hand-outs were snatched up quickly.
The checklist includes detailed questions you can ask about your state managed care program, including: Does your state contract with and provide dedicated funding to an independent ombudsman to address individual consumer problems and identify systemic problems? Does the state require a face-to-face assessment of each consumer that examines physical, mental and functional strengths and needs, personal goals and preferences?
Does the state have a comprehensive quality strategy that annually works to improve consumer quality of life, health and functional status?
The checklist is designed for Medicaid managed LTSS, but many of the measures apply to all managed care. Try it on your managed care plan for people eligible for both Medicaid and Medicare (dual eligibles), or the managed care variety sprouting in your state. Use it to engage stakeholders and state officials in a fruitful dialogue.
The checklist is based on federal guidance released in May, Community Catalyst’s paper “Putting Consumers First: Promising Practices for Medicaid Managed Long-Term Services and Supports,”and stakeholder recommendations on meeting consumers’ needs.
Please check it out.