Going for the Gold by Helping Consumers Get Good Care
If sports offer lessons for life, we might look to Sochi for a few pointers. For starters, the Sochi Olympic Winter Games attracted more participants than ever. But as those of us glued to our televisions have seen, the path to gold is treacherous. Most winners need a good coach, a clear understanding of the required elements, and the talent and work ethic to put it all together.
Halfway across the globe in the United States, a program where the stakes are much higher is also attracting more competitors. In 2013, three more states turned over Medicaid long-term services and supports (MLTSS) to managed care companies, bringing the total to 19, according to the consulting and research firm of Truven Health Analytics. By the end of this year, Truven estimates that more than 1.1 million older adults and people with disabilities will get their care through these programs.
As at the Olympics, many of the MLTSS players—companies and states—are stumbling and a few are crashing, and most of the competitors do not have all the elements they need to create a winning program. Community Catalyst has launched a new web-based tool that not only lays out the required elements, but also provides examples that advocates and other stakeholders can use to push companies and states to perform better. (Attend a webinar to learn more.)
With support from The SCAN Foundation, Community Catalyst developed this tool to improve care for consumers by making it easier to identify weaknesses in MLTSS and promote better practices. The tool combines a checklist for assessing and shaping MLTSS with examples of practices, policies or contract language that implement the criteria. The tool can be used with stand-alone MLTSS, all-encompassing Medicaid managed care programs, or demonstration projects for people with both Medicare and Medicaid.
The tool covers dozens of elements in nine categories: Adequate Planning; Stakeholder Engagement in Design, Implementation and Oversight; Consumer Support and Protections; Enhancing Home and Community Based Services; Person-Centered Processes; Comprehensive Integrated Service Package; Provider Quality, Quantity and Continuity; Overall Quality; and Oversight.
For example, in Person-Centered Processes, a required element is a needs assessment of each consumer that examines physical, psychosocial and functional strengths and needs, personal goals and preferences. Winners in this category include Washington state, which uses a comprehensive assessment tool called CARE, and Michigan, which uses the InterRAI‐Home Care assessment tool.
In Provider Quality, Quantity and Continuity, a required element is a provider pool that is culturally and linguistically competent, to match the diversity of the participants. Minnesota’s Senior Health Options contract requires managed care companies to 1) provide consumers with access to providers who are culturally and linguistically competent in the language and culture of the consumers, and 2) work to expand the pool of providers who are culturally and linguistically competent.
Of course, having the required elements—good contract language or policies—isn’t enough. Consumers will only be well-served if these elements are effectively executed and melded into a cohesive program. So it is essential that advocates and other stakeholders actively monitor and score MLTSS programs. Required consumer engagement strategies in the tool include a state-level stakeholder planning and oversight committee with at least 50 percent consumer representation, such as the Massachusetts Implementation Council.
For training on the tool, please join us on a webinar entitled Making Managed Long-Term Services and Supports More Consumer Focused that will be hosted by the coaches at the federal Administration on Community Living on Tuesday, March 4 from 3:00 p.m. to 4:00 p.m. Eastern Standard time.
Then, push your state to go for the gold!