Many health plans and accountable care organizations (ACOs) are working with Medicaid programs to transition fee-for-service long-term services and supports (LTSS) to a managed care model known as managed LTSS.
The goal: successfully support individuals to live and work in the setting of their choice and maintain quality of life – while receiving the most appropriate package of services to improve health outcomes and reduce costs.
Some payers are challenged in developing effective systems to manage the care of the populations they serve in a cost-effective manner because they need a better understanding of the MLTSS framework. Using experience gleaned from developing and implementing a wide range of LTSS programs, UMass Medical School can help with:
- Developing LTSS clinical guidelines
- Conducting comprehensive needs assessments
- Designing person-centered and integrated LTSS service plans
- Creating care transitions processes
- Utilization management
- Complex case management
- Prior authorization
- Program integrity
- Developing quality and performance measures
- Building provider networks
- Designing and delivering training
Building a successful Long Term Services and Support program starts with creating strong clinical guidelines, says Jessica Carpenter, Senior Director of Disability and Community Services. The goal is ensuring individuals receive the right service, in the right setting, and at the right time.
Jessica Carpenter discusses why states should guarantee contracts for Managed Long-Term Care plans include requirements for policies, guidelines, and processes that will provide the appropriate services to members, manage utilization, and ensure the state’s funding is used appropriately.
