Home care is an important benefit for many Medicare Advantage and Medicaid recipients. The problem, though, is how are home care benefits being measured and assessed?
Have you worked with a Medicare Advantage plan yet as part of their home care and supportive service offerings? Roughly half of older adults and Medicare-eligible members chose to use Medicare Advantage for their benefits over Original Medicare.
One of the chief reasons is because of the additional value-added benefits they offer on top of the existing regimen like dental and medical care.
What has been missing from the Medicare Advantage equation is the oversight and measurement of care delivery, particularly for not primarily health-related benefits. Here’s an overview of what we’ll talk about today:
Medicaid has served as an example of innovative care delivery for diverse patient populations and groups. Medicaid Managed Care and similar programs via waivers have proven to not only lower barriers to care but also demonstrate efficacy in the form of performance measures. This could include measurement by:
What these sets of performance measures do is establish objective ways to assess, critique, and improve the delivery of care across multiple sides of operations.
There are many ways to assess how care is delivered, but what does that mean for your home care agency? The standards set for payers are a golden ticket for you to develop and nurture relationships with payers and other key stakeholders.
For example, with Long-Term Services and Supports, here are a few metrics that you can focus on.
This is one of the first impressions you make on a client. Coming into the home, you have an opportunity to explore beyond what a client says they need help with.
If you haven’t already, work toward moving beyond paper care planning. Document these in your agency management system for seamless information sharing with your team, caregivers, clients, family members, and other key stakeholders.
Assessments that meet the mark have to include the following elements:
Using care plans that are thorough and go into detail will not only streamline communication within your team, but make life easier for your caregivers having one place to reference this information. It’s especially helpful if they take a client to an appointment.
Although you can’t prevent every fall from happening, when caring for clients it is important to assess their home for safety but also understand what might put the client at a higher risk for falling.
For Medicaid, fall prevention is an important performance measurement and taking the proper steps to make sure that you keep clients safe should be a top priority. Work together with any other providers that see the client and make sure you’re on the same page. Here are some best practices:
One-third of seniors fall each year. Maintaining balance can become increasingly hard as they age. One of Medicaid’s goal in this category for providers to help clients:
Again, not all falls or balance issues are preventable, but home care providers like you share a responsibility with the family to keep the client safe and healthy at home.
How can you help clients and providers when it comes to balance?
Those are the three performance measure categories for long-term services and supports. Here’s how Medicare can do better in following Medicaid’s footsteps.
Let’s set the stage. Seniors are continuing to make the choice to switch from Original Medicare to Medicare Advantage, in the hopes that they can have choice, lowered costs, and access to additional benefits.
According to a recent report from Leavitt Partners, “Beneficiary demand for—and inconsistent data collection and inconsistent oversight of—promising supplemental MA benefits has created a $70 billion black box that should be illuminated and strengthened using established accountability measures from the Medicaid program.”
Medicare Advantage plans hopped onto the idea of value-added benefits early on, which is great. However, they didn’t put proper checks and balances in place to ensure that the quality of benefit delivery met member expectations. And did they improve member health outcomes? That is the unknown here.
Firstly, Medicare Advantage (MA) plans used independent contractors to supply caregivers. This created a unique set of challenges for assessing care quality from the client’s and payer's sides.
Payments to MA plans have grown over the last several years, but what we need to find out is:
The report recommends using Medicaid’s regulated approach to home care (relying on home care agencies over independent contractors), and utilizing set standards to measure beneficiary care and provider quality.
2024 is the year for exploring new opportunities for your payer source mix.
We are optimistic as the growing number of supplemental benefits continues to acknowledge taking in member feedback and offering what people want. If your agency is looking for a new agency management system that’s able to manage the payer mix you’re developing, consider switching to CareTime today.