Prior to the 2008 passage of the Long-Term Care Community Choices Act, Tennessee was spending 99 percent of its Medicaid long-term care dollars on nursing homes instead of home-based services.
One of the largest TennCare managed care organizations in the state is replacing its care management software to enable its transition to full implementation of the program by March 2010.
Volunteer State Health Plan (VSHP) is implementing CH Mack’s Q Continuum System, a more specialized, integrated software that provides more capabilities than the program requires, said Maresa Corder, director of Home Base & Community Services.
VSHP will be able to maintain parity in service levels for Medicaid recipients regardless of location in the state because Q Continuum’s algorithms used for level-of-service determination are the same statewide. “The RN or MSW conducting the assessment, which is the basis of the service plan, can modify the plan of care based on need, in compliance with evidence-based guidelines,” Corder said.
As more members move back to their homes and communities, VSHP will rely on Q Continuum to safely manage the volume and, more importantly, the increase in quality of services that will improve the quality of their lives, she said.
CH Mack has been supporting managed long-term care programs in numerous states, including California, Florida and New York, said CEO Chris Boue. Its software enables deep assessment involving medical, behavioral and social components to help develop a comprehensive care plan tailored for the beneficiary.
While Mary Kahn, Medicaid spokeswoman for the Centers for Medicaid and Medicare Services, said that the rebalancing initiatives are too new to have any conclusive evidence as to their effectiveness, Boue believes that the consumer-directed managed healthcare program represents an emerging national trend. The elderly and disabled will have long-term, managed care options that will allow them to remain at home and receive affordable, quality healthcare services, he said.
“IT will be a key enabler in improving long-term managed healthcare because consumer-directed and self-determination programs allow family members, caregivers and medical professionals the opportunity to get involved in the care management of their loved ones and patients,” he said.
