Managed Long-Term Services and Supports (LTSS) Advisory Services and Program Operations
A complex and evolving LTSS environment
An expanding independent living movement, where more individuals with disabilities seek to live in their own homes or in a community setting, has dramatically increased demand for LTSS. At the same time, varying costs, inconsistent service across provider types, and workforce shortages create challenges in LTSS delivery for managed care organizations (MCOs). The LTSS program market is fragmented and doesn’t support well-coordinated services for members with complex care needs—precisely those who rely on LTSS. The result may compromise health outcomes and increase costs.
Managed Long-Term Services and Supports (LTSS) Solutions
Commonwealth Medicine offers a suite of LTSS services for MCOs that improve service delivery, contain costs, and bring innovation to the Medicaid managed care market. With over 20 years of experience and expertise in clinical, policy, and financing approaches—including experience serving as senior-level state Medicaid executives, agency leaders, and program directors—our staff has a deep understanding of populations with complex health care needs and the importance of LTSS to successful community living. Our LTSS services include:
- Information and Referral: We stand up innovative, centralized online referral resource and member service centers to connect members and their caregivers to multiple LTSS services. Scalable and highly transferrable, our high-touch, closed-loop referral process supports member- and provider-directed referrals.
- Provider Network Development and Maintenance: Our expertise in LTSS provider network administration enables us to design, develop and implement approaches that enhance compliance, reliability, continuity, and quality oversight, as well as credentialing and claims processing. We support LTSS provider networks with outreach, recruitment, and staff training in best practices for working with health plans.
- Utilization Management: We are leaders in the design, implementation and provision of LTSS clinical assessment, clinical guidelines, and prior authorization processes, including competency models for clinical assessors. Our best practices improve coordination and compliance in complex case management, utilizing in-home evaluations and person-centered care plan development for cost-effective community-based care delivery.
- Social Determinants of Health: We build programs focused on delivering person-centered services to improve health equity and reduce health care disparities. Our knowledge of community supports, linguistic and cultural competency, and quality of care measurement help us design programs that support employment and vocational training, community integration, health literacy, and food insecurities.
- Workforce Development and Training: We provide online and in-person training for health plan staff, clinicians, and providers on LTSS best practices to address all populations’ complex needs.
- Analytics for Medicaid Business Intelligence: We manage, analyze, and report on LTSS service data for MCOs delivering services to Medicaid members. We have experience analyzing Medicaid claims, Minimum Data Set, and other data for pricing, risk adjustment, quality measurement, and other uses.
- System Design: With deep expertise in law, financing, claims data, demographics, and policy and program development, our team helps managed care plans to implement state and federal regulations, oversee procurement and contracting, create integrated care programs, measure quality, collect data, and report outcomes.
- Program Implementation: We are leaders in the design, development, and implementation of programs, including database systems that support older adults and people of all ages with disabilities, including those with physical, intellectual and developmental brain injuries, and mental health and substance use disorders.
- Program evaluation and monitoring: We apply advanced survey and data analytics and performance measures to monitor and evaluate the quality (including star ratings), cost, value, and impact of LTSS on member outcomes. We deliver findings that support MCOs’ quality improvement strategies and enhancements in service delivery.
- Strategic Innovation: We offer operational and strategic innovation support to facilitate strong partnerships with state Medicaid agencies.
Additional managed care services offered by Commonwealth Medicine:
- Member Outreach Services: Our full-service, clinically-based call centers provide our clients with essential service capacity they would not otherwise have to expand outreach to members, patients, and providers, coordinate surveys, assist with benefits, and more. The result is improved member engagement and satisfaction and improved health outcomes for members.
- Value-based Purchasing: We analyze data to identify health disparities, enabling us to develop value-based purchasing (VBP) strategies to improve covered lives outcomes. We identify evidence-based programs approved for VBP models that promote delivery system transformation, shifting providers’ focus on improving health outcomes. Our guidance on procurement, contracting, and quality measurement facilitates improved population health outcomes and cost-savings.
- Pharmacy Pipeline and Budget Impact Forecasting - Our comprehensive clinical and financial assessments of the drug pipeline result in pharmacy budget impact forecasts customized to your plan’s population through claims analysis. The critical intelligence gained helps eliminate surprises in medication spend across pharmacy and medical benefits, supports contract negotiations and facilitates proactive formulary planning and clinical program implementation.
- Physician-Administered Drug (PAD) Prior Authorization - Our robust PAD program identifies cost-savings opportunities and gaps in utilization management across pharmacy and medical benefits. Our contact center performs prior authorizations and provider notifications and delivers efficient reporting and analytics. We also work with managed care plans to explore medication-related cost-savings at other care sites, such as hospital outpatient and inpatient settings.
- MCO Oversight and Innovation - Operationally, we provide an experienced pharmacist liaison who helps build strong partnerships through close coordination with the Medicaid pharmacy program. We ensure that the MCO formulary criteria and protocols are comparable to the fee-for-service program. And we establish quality controls to ensure operational alignment (e.g., accurate implementation, point-of-sale claims adjudication, and coding). Strategically, our policy research and recommendations identify innovative Medicaid practices to help contain costs while ensuring medication access for all members (e.g., value-based pricing and outcomes arrangements)
How can we help your organization?
A well-structured LTSS framework help builds a robust and accessible provider network structure and supports service delivery for individuals, helping with enrollment and understanding of benefits and rights. Commonwealth Medicine’s expert, cross-disciplinary LTSS team includes policy and program consultants, nurses, social workers, and occupational, physical, speech and respiratory therapists with many years of experience in LTSS design and delivery at both the individual and system levels. Let's start a conversation about how we can be of service to your organization and the vulnerable populations you serve.