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By Sarah C. Threnhauser

We are seeing a lot of change in the long-term services and supports (LTSS) market: First, we are increasingly seeing LTSS shifted to competitive managed care models (see Changing Financing Of Long-Term Services & Supports – A New Business Model In Its Wake). Second, the demand for LTSS is growing as the demographics of the population (both over and under 65 years of age) in need of assistance with activities of daily living is also increasing (see More Than 20% Of 85+ Adults Need ADL Assistance).

The policy goals around these shifts are straightforward: The goal is to improve consumer health status and decrease costs with better care coordination of all types of Medicaid funding for consumers with multiple chronic conditions and disabilities (many of whom are dually eligible for Medicaid and Medicare). However the delivery changes this shift has produced are pronounced—there are new managed care rules and performance-based reimbursement for services and provider organizations previously not working in organized systems of care, new technology requirements, and more community-based service delivery.

Leigh Davison

To get a sense of how this shift is playing out on the ground, we turned to someone who is making this work in practice—Leigh Davison, Staff Vice President, Medicaid and LTSS Specialty Organization, Anthem, Inc. Ms. Davison talked with us about how Anthem is managing LTSS and offered her perspective on how provider organizations and health plans can partner together to build a successful LTSS model of care. For executives interested in opportunities in the changing LTSS market, there were a few big takeaways from our discussion—First, think in terms of whole person care; second, invest in technology; third, clearly define roles in all partnerships; and finally, let health plan and provider organization partnerships evolve over time.

Think in terms of whole person care—More payers are looking to build whole-person models of care, with an eye to the inseparability of physical health and behavioral health. With that in mind Anthem directly manages its physical and behavioral health care networks. Ms. Davison explained:

This allows us to better partner and integrate these services into an individual’s care plan and assure that our approach is recovery focused and strengths based. We leverage our network of providers, Anthem clinical practices, and guidelines so that we can address the unique physical, behavioral health, and social support needs of each of our members, aiming for reduced fragmentation of care and improved outcomes.

Invest in technology—Technology plays a major role in managing the shift to whole-person care. She explained:

We are focused on leveraging technology and innovations so that we can meet the needs of our state partners, stakeholders, and individuals driving quality solutions and outcomes. When you look at LTSS, the majority of the spend is in custodial nursing care and personal attendant care. One of the things we want to do is look at the value-based programs for those providers. We had to look at what tech and tools you must make available, desired outcomes and then how can we offer solutions to meet the needs of our members, providers and state partners.

Technology enhancements allow us to better document activities of daily living, make available care plans and assessment to provider and members, and assess outcomes related to member goals and preferences as well as traditional health outcomes. Leveraging tech so you have the capabilities for anyone on the care team to review and provide input on the member’s assessments, care plans, and support documentation is extremely important.

One specific technology tool that Anthem is using with LTSS is Care Heroes, a system that tracks and reports their member’s in-home services and supports and submit daily notes and observations. It is “available through a secure web and mobile platform, helps identify gaps and avoid service duplication. The care coordinator can view information real-time and can contact the member, family and provider as necessary to respond to any issues” (see Anthem HealthKeepers Plus Provider Manual).

Build clearly defined partnerships between health plans and provider organizations—As Anthem is moving forward to work with provider organizations to manage LTSS, one big challenge has been to ensure that the roles and responsibilities have been defined by all parties creating a seamless coordination. Ms. Davison explained:

It is important as you partner with provider organizations that you ensure that the roles and responsibilities have been defined by all parties creating a seamless coordination as we all work to support the individuals that have trusted us to serve and support them. It will be important to leverage technology, innovations, and tools to share data while doing this. Examples include care plans, assessments, authorizations, and utilization. This supports reporting, training, and education thus driving satisfaction and quality outcomes. By taking this approach it creates an environment for individuals to live their best life.

Grow partnerships slowly and allow them to evolve over time—It’s important for both health plans and provider organizations to understand the other side when initially coming to the table, including what depth of knowledge each side has. You both must get to know each other and find opportunities to build a relationship and collaboration. Ms. Davison explained:

When we come to the table initially, for me, it’s like walking before you can run. Many provider organizations have been in the community for years, and they know what is working and what isn’t working. What can provider organizations bring to the table? We want to find those that really want to partner by collaboratively developing innovative approaches. Often, organizations will come to show you what they have, but they want to run it as they always ran it. This makes it difficult to leverage shared resources and develop innovative and scalable solutions. You want a provider organization that can scale the innovation across the board, even in a certain area or region, or even state wide. Both parties must give a little and make it a partnership. And then after, turn it into a risk sharing arrangement if both parties are ready to take this next step. We ultimately want to support partners in growing their business acumen so that they are equipped as full partners in risk and benefit sharing arrangements.

For more about MLTSS, check out our series of OPEN MINDS Market Intelligence Reports:

  1. State Medicaid Programs With MLTSS: The 2017 OPEN MINDS Update
  2. What Are The Medicaid Financing & Service Delivery Systems For The I/DD Population Receiving LTSS?: An OPEN MINDS Market Intelligence Report
  3. What Is U.S. Spending On Long-Term Services & Supports By Service Type?: An OPEN MINDS Market Intelligence Report
  4. What Does The U.S. Spend On Long-Term Services & Supports, By Payer?: An OPEN MINDS Market Intelligence Report

To learn more about the future of LTSS and how Anthem is working with provider organizations to manage LTSS in our shifting market, don’t miss Ms. Davison’s keynote address, Innovative Collaborations & Partnerships For Long-Term Services: The Anthem Perspective, on February 15 at The 2019 OPEN MINDS Performance Management Institute.

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