Title text here NCSL Fall Forum Preconference Session: Quality & Consumer Issues in Medicaid Managed LTSS December 3, 2013 Wendy Fox-Grage Senior Strategic Policy Advisor AARP Public Policy Institute Role of State Legislators Lawmaker Financier Regulator Convener 1
Consumer Issues & Concerns Losing access to long-term services and supports providers Reduction of services to lower costs Possible interruption of services during transition to managed care (as well as transparency) Lack of consumer education AARP Policy on Quality Measurement Preference for national metrics -- measures that are standardized, valid and reliable (National Quality Forum) Comprehensive patient experience across settings of care & information on cost and resource use (efficiency) Publicly reported 2
How do Programs Measure LTSS Quality? Quality management programs with LTSS specific measures Lack of a nationally endorsed set of measures, so great state variation & modifying of measures Lack of infrastructure for electronic health records for long term services and supports providers More difficult to measure quality of care and quality of life outcomes Source: NQF/MAP 3
What do we want in LTSS? To live at home and in the community To live as independently as possible Can use data to set benchmarks for MLTSS: Medicaid balancing toward home and community-based services Preventing hospitalizations Medicaid HCBS Spending as a Percentage of LTSS Spending, for Older People and Adults with Physical Disabilities, 2009 Source: Across the States 2012: Profiles of Long-Term Services and Supports. Ari Houser, Wendy Fox-Grage, and Kathleen Ujvari. AARP Public Policy Institute, September 2012. 4
Percent of Long Stay Nursing Facility Residents with a Hospital Admission, 2008 WA MT ND VT NH ME CA OR NV ID AZ UT WY CO NM SD NE KS OK MN WI IA IL MO AR MS MI IN OH WV KY TN SC AL GA NY PA VA NC MA RI CT NJ DE MD DC < 15% 15 20% AK TX LA FL 21% + Data not available HI Source: Across the States 2012: Profiles of Long Term Services and Supports. Ari Houser, Wendy Fox Grage, and Kathleen Ujvari. AARP Public Policy Institute, September 2012. Percent of Home Health Patients with a Hospital Admission, 2008 WA MT ND VT NH ME CA OR NV ID AZ UT WY CO NM SD NE KS OK MN WI IA IL MO AR MS MI IN OH WV KY TN SC AL GA NY PA VA NC DC MD CT NJ DE RI < 28% 28 31% MA TX LA 32% + AK FL HI Source: Across the States 2012: Profiles of Long Term Services and Supports. Ari Houser, Wendy Fox Grage, and Kathleen Ujvari. AARP Public Policy Institute, September 2012. 5
What do consumers want? The Goals: Bi Bring better care coordination i Improve transitions between settings Create new options in home and community-based services View families as partners in care Family Caregivers Move to interdisciplinary teams should include the family caregiver er At very least, family caregiver s contact info should be in medical records Family caregivers shouldn t leave care settings uninformed Assessment of caregiver s needs 6
What Needs to Change? Better care coordination Harmony between Medicare and Medicaid Access to a high quality continuum of care (primary, acute, behavioral health, and long-term services and supports). More efficient care in terms of cost and delivery of care. Improved experiences of care for Medicaid recipients and their caregivers Major Expertise Needed for Change Ensuring strong state oversight Experience working with frail older people, people with disabilities Blending health and social services Coordinating care for high cost individuals Measuring gquality of life and care Training LTSS workforce 7
Person and Family-Centered Care Consumer-centered assessments and care planning. More emphasis on prevention and social services. Incentives that support preferences for receipt of LTSS in community settings. Incentives that support balancing. Putting Consumers First Consumer Involvement: Consumers need to be actively and meaningfully involved during every step of the process and on an ongoing basis. Consumer Education: Consumers must have access to ongoing, unbiased information and education. Transition plans: No abrupt termination of long-standing relationships with traditional providers. 8
Putting Consumers First (con t) Transparency: Consumers need to be able to make choices based on information they receive from independent, disinterested parties (i.e., enrollment brokers). Continuity: Consumers need the broadest possible provider networks, so they experience the least disruption. The Bottom Line Governments are in the beginning stages of trying to see what works best for delivering high quality care to a population with complex health care needs. LTSS must be part of the solution Out of the churning, innovations can emerge The health and well-being of vulnerable consumers is at stake. 9