More than 12 million individuals currently use Medicaid long-term services and support programs (LTSS). That number is only expected to increase as America’s aging population grows.
As more and more individuals access ongoing care, states need to employ strategies to ensure patients receive high-quality services while keeping costs low. Given the high cost of institutionalized care, states should prioritize community-based care in order to:
We’ve outlined three quality improvement strategies in healthcare to help states achieve these outcomes.
1. Assessments early and often
LTSS is not one-size-fits-all; each patient has unique and dynamic health challenges that states need to address. This is why initial and ongoing patient assessments are crucial in determining which services patients will need throughout their course of care. The benefits of this are twofold:
- Assessments can identify key risk areas early (such as a risk for falls) that can be addressed to prevent expensive consequences later on (a broken hip).
- Ongoing assessments can also prolong patient community tenure.
For example, a patient might have vision and mobility challenges that make it difficult for them to run errands outside their home, but they are almost fully independent within their home. In this case, it would make more sense for them to receive in-home care, rather than fully institutionalized care. This strategy preserves the patient's independence while also avoiding the expense of long-term residency in a care facility.
2. Include social determinants of health
An individual’s overall health includes much more than what goes on in the doctor’s office. Their health is also influenced by social, economic and community factors, known as social determinants of health. These external factors are some of the most important components in assessing a patient’s ability to stay within their communities.
For example, does this patient have a reliable way to get around without a car or license? In rural communities, public transportation might be minimal or nonexistent. This can influence a patient’s ability to attend appointments or pick up prescriptions, increasing the risk of non-adherence.
Other examples of social determinants of health include:
- Family or friends that can support the patient with their daily care needs
- Safe housing in both design and location
- Access to community-based recreational activities
Although these factors might not be immediately apparent in a doctor’s office, they are some of the most important influences on a patient’s ability to remain within their community. Therefore, addressing these needs with wraparound social and medical services is key in improving the quality of LTSS care.
3. Leverage patient data
Identifying areas to improve state LTSS is a lot easier with data. This is why it’s crucial to collect and analyze LTSS patient data regarding both utilization and quality of care.
This includes qualitative and quantitative data, such as:
- The total number of services and supports patients access
- Scores from patient functionality assessments
- Patient and provider sentiment regarding overall quality of services
These findings can then be cross-examined against factors such as individual diagnoses, location, provider and overall compliance to identify trends in quality and utilization.
With these insights, states can improve LTSS quality through tactics such as provider training or community program development. For example, if one provider network seems to provide an inflated number of institutional care plans for their patients, states can provide training to teach those providers community-based alternatives for addressing patient needs.
Balancing quality of care with increasing demand
Overall, states’ main priority in increasing the quality of LTSS should be increasing the community tenure of patients.
As America’s population ages — and demand for LTSS increases — these tactics will only become more important. By implementing the strategies outlined above sooner rather than later, states will be in a better position to anticipate and react to these changes.
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