I think managed long-term services and supports (MLTSS) is in the process of remaking the concept of managed care. This was my conclusion following the remarks of Leigh Davison, Staff Vice President, Medicaid and LTSS Specialty Organization at Anthem, during her keynote presentation, Innovative Collaborations & Partnerships For Long-Term Services: The Anthem Perspective, at The 2019 OPEN MINDS Performance Management Institute. MLTSS programs requiring taking the concept of “whole person care” and “integration” one step further. Why? According to Ms. Davison, the focus is not just management of use of “health services” but supporting the consumers in way that keeps 80% or more of MLTSS beneficiaries living in the community.
During her presentation, Ms. Davison spoke of three key elements in this managed care service evolution. The elements are moving past person-centered planning to be a person-centered organization, collaborative support of the consumer environment, and a consumer-centric focus on value in contracting.
Using person-centered thinking to create the person-centered organization
Ms. Davison spoke of Anthem’s changing frame in system—with the member at the center. This system includes health care but leveraging technology and community assets are key. To do this, Anthem has moved from person-centered planning to becoming a person-centered organization using person-centered thinking.
Collaborative management of the consumer environment
But person-centered service delivery demands a broader service delivery system—one that is collaborative across multiple stakeholders and offers expanded services to support consumers in the community. The expanded services in the Anthem conceptualization of consumers supports gives a good direction of where “whole person” care is heading. Ms. Davison spoke to housing, transportation, and nutrition as core elements. Interestingly, she also mentioned access to treatment for co-occurring mental health and addiction treatment as a critical service. For example, Ms. Davison shared the Blue Triangle Housing Program, which is a partnership between the City of Indianapolis, a non-profit housing organization, and a community mental health center (CMHC). The city if Indianapolis covers the cost of room and board, the non-profit housing organization helps locate housing, and the CMHC provides wrap-around services. Since May 2017, 111 people have participated in the program, 68 individuals completed the program, and 62% moved into stable housing or a better program for their needs.
The central construct to this expanded service array is health homes—facilitating collaboration across a broad array of stakeholders from housing organizations to provider networks. Ms. Davison gave an example of a LTSS-specific program where Anthem care managers referred individuals at risk of readmission to the local Area Agency on Aging (AAA). The AAA then assesses care coordination needs and reports to Anthem on status and outcome. For individuals who had a face-to-face visit with the AAA, readmission rates were 31.2% lower than those who did not have a visit.
In addition, technology is central to this health home coordination and collaboration. There were great examples of technology—using care coordination technologies (like Mozzaz and Care Heroes), tech platforms for electronic visit verification, and Project Echo to link clinical professionals with subject matter experts.
Value-based contracts with service delivery organizations
Lastly, Anthem is shifting their relationship with provider organizations to an array of value-based reimbursement options. Ms. Davison said that 59% of Anthem provider organization are now in VBR arrangements. She gave an example—the Anthem Personal Care Attendant incentive program. In this arrangement, the incentives are focused on consumer service and outcomes, with a goal of enhanced use of prevention and primary care.
For more on this evolution of managed care, join us at The 2019 I/DD Executive Summit in New Orleans on June 3 for the session, “From Managed Care Planning To Execution—The Future Of Financing & Service Delivery Models For The I/DD Market” featuring Josh Boynton, Vice President of Aetna Medicaid.