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By Sarah C. Threnhauser

There is change in the long-term services and supports (LTSS) market and to get a better view of what that change looks like, I sat down a couple weeks ago with Leigh Davison, Staff Vice President, Medicaid and LTSS Specialty Organization, Anthem (see LTSS Drives Whole Person Care Strategies). For executives interested in LTSS opportunities with health plans, she spoke of four key ingredients to those relationships—investments in whole person care, technology evolution, partnership development, and adaptability in those partnerships.

But are there strategic elements that are necessary to make those relationships possible? I think so. A recent analysis by Cantata Health, The Future of Long-Term Care: Predictions for 2019, put a point on the what is needed for organizations providing long-term services. Their take on the strategic issues identified five areas of focus.

“Competitive” will mean specialized care—Like all of health care, payers and health plans are looking for more targeted services from long-term care providers. More consumers in long-term care services suffer from serious medical conditions, as well as ongoing diabetes, obesity, mental health, and opioid epidemics. Addressing the specific needs of these consumers are opportunities for differentiation.

Technology is the key to minimizing burnout—”Burnout” continues to make headlines when it comes to the health care workforce, but so does the biggest solution to that burnout: technology. By augmenting the workforce with newer and better tech tools, provider organization managers can re-conceptualize the services and value they deliver and how they deliver them (see Preparing For Your ‘Augmented’ Workforce).

Engagement is the next big innovation—Long-term services and supports are just that, long-term. And decision makers about consumer care often span the generations. Provider organization executives need to understand, and excel at, how to address the communication styles of every generation. Experience management (and auditing), net promoter scores, consumer engagement strategies, and online reputation management are all part of coming best practice (see How Technology Is Changing Case Management).

Data-driven decision making isn’t a future trend, it’s SOPMargin pressure in traditional reimbursement models and value-based managed care reimbursement will change the metrics that executives need to navigate and remain sustainability. Metrics-based management and decisionmaking need to be standard operating procedure (SOP). For those executive teams that have adopted metrics-based management approaches, the key is to increase their data sophistication so that they acquiring usable information and not just piles of data (see The Perennial Challenge For The New Year: Strategic Execution).

Focus on accurate coding—Changes in coding are coming in the long-term care space and failure to keep up with changes in coding means loss of revenue. The Centers for Medicare & Medicaid Services (CMS) is planning to replace its existing nursing facility case mix system effective October 1, 2019, and will implement the Patient Driven Payment Model (PDPM) to replace the existing Resource Utilization Group (RUG), Version 4 case-mix methodology (see Federal Nursing Facility Case Mix Payment Changes Planned For October 2019). The PDPM focuses on a resident’s condition and care needs, rather than the amount of care provided, to determine reimbursement levels.

For our recent coverage on the LTSS market, check out:

  1. Number Of California Seniors With Disability Projected To More Than Double By 2060
  2. MyCare Ohio Duals Demo Cut Inpatient Utilization By 21% In Year One
  3. Illinois Medicare-Medicaid Alignment Initiative Reduced Inpatient Utilization By 15% In First Year
  4. Pennsylvania Medicaid Launches Southeast Region Enrollment In Community HealthChoices, Mandatory Managed Long-Term Services & Supports
  5. Medicaid HCBS Review Finds Key Challenges In Workforce, Growing Consumer Complexity, & Funding Limitations
  6. LTSS Investment-& Restructuring- Speeds Up
  7. Medicaid HCBS: Selected States’ Program Structures & Challenges Providing Services
  8. Wisconsin Medicaid Family Care Plan Pay-For-Performance First Payments In 2019
  9. Alaska Governor Signs Law To Support Self-Determination In Developmental Disability Services
  10. Alabama Medicaid Announces Selection Of Alabama Select Network For Long-Term Care Case Management

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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