ANCOR Session Recap: Moving from a Service-Based to Outcome-Based Approach for Managed LTC

CareDirector were delighted to attend and exhibit at last weeks ANCOR conference in Chicago. In case you missed it, here is a session recap you may find of interest. Presenters included Jesse Smathers of Smoky Mountain MCO and Chris Wolf of TIL Consulting.

  • There is a national movement towards a healthcare system that pays for value instead of volume for the Managed Long Term Supports and Services (MLTSS) of the disabled long-term care (LTC) population. The volume-driven Fee-for-Service payment system is being replaced with pay-for-performance and care management initiatives, including performance-based contracting to providers and MCO’s.
  • As dozens of states move from fee for service to managed care models of funding it places new burdens on to service providers.
  • Major areas of caution for providers working with MCOs are contracting, pricing and billing.
  • To be successful LTC providers may need to change their entire business model and make sure that they have the flexibility in their technology to handle multiple billing systems, more complex pricing structures and the ability to automate workflows to ensure reimbursement for services.
  • Opportunities also exist with the move to MCO models. Care coordination post-hospitalization, additional transport services and case management for a continuum of care that includes PCP, dental and psychiatry are all areas that could be leveraged to grow services and improve quality of services.

Key Questions to Reflect On for the Future…

  • Do you have an electronic health record with flexibility to manage contracts with multiple MCOs?
  • Are you investing in technology to enhance your services and supports?
  • Are you engaged in whole person collaborative care?
  • How are you collaborating with other community partners?
  • Are you developing an expertise to be competitive?
  • Are your ready for “pay for performance” contracts?

These changes give us all a lot to think about. If you would like to talk more about your current technology needs, simply email us at [email protected], or click this link which takes you to our two-minute provider solution video that describes how we can help your agency build technology capacity that saves you time, money and improves quality.