Measuring the Real Value of Managed Long-Term Care Health Plans
Year-end corporate messages typically summarize progress made in the prior months and offer projections of success for the coming year—all supported by volumes of complex metrics that inevitably point to a dollar amount. But, when the defining goal of an organization is to maintain the health and foster the well-being of vulnerable populations who have slipped through society’s safety net, success is harder to quantify.
The real value a health plan brings can be measured in many ways—for example, by a health plan member whose physical therapy enables her to overcome mobility problems and walk to the grocery store on her own. Or, by a plan member with diabetes who lowers blood sugar levels through a program of education, diet, and exercise. When a social worker helps an older person learn to cope with the anxiety that comes from living alone, we see value there as well. Sometimes, the most ambitious goal of a plan member’s care is simple stability—making sure an individual doesn’t lose ground to illnesses and is prepared to survive life’s unforeseen challenges.
A Medicaid Managed Long-Term Care (MLTC) plan offers all this and more. MLTCs are New York State Medicaid plans designed to help chronically ill or disabled individuals live safely and comfortably in their own homes and communities. Members can receive services ranging from monitoring of illnesses and wound care and assistance with basic functions like bathing, dressing, walking and preparing food, to referrals to community resources and the education of family members and caregivers. And as recent outcomes show, this array of services is having a positive impact on both people’s health and the healthcare bottom line.
Coordinated Care Allows Personalized Member Focus
A pioneer, innovator, and leading national advocate for home and community-based care, the Visiting Nurse Service of New York (VNSNY), the non-profit where I work, was founded in 1893 with a mission of compassion and care for indigent, chronically ill, physically compromised, and elderly New Yorkers who had nowhere else to turn. In keeping with our mission, VNSNY offers two types of plans for people who need long-term services and supports: VNSNY CHOICE MLTC, and the VNSNY CHOICE Total Medicaid Advantage Plus (MAP) plan. Our recent experiences, and those of our plan members, point to just how successful—and valuable— managing long term services in the home can be in creating positive member outcomes.
Jeanette, who is 69 years old and suffers from diabetes, has been a CHOICE member since 2007. When she was diagnosed with diabetic neuropathy, her care coordinator ordered the required wheelchair for her, and sent physical therapists, occupational therapists, and others to her home to assess her care needs and to help her adjust to her new situation. She receives a monthly visit from a nurse to evaluate her medical status, has daily care from a home health aide, and also gets as-needed home visits by vision, foot care, and dental specialists.
Her care manager Seth, and her home health aide (HHA) Tamia, also helped Jeanette make lifestyle changes like having more nourishing food, that have put her on a healthier path—in 16 months she dropped two dress sizes and lowered her hemoglobin A1C (a blood sugar measure) from at-risk to normal levels. “VNSNY cares,” says Jeanette. “Even though they’re dealing with thousands of people, they treat me as an individual, helping me feel important and good about myself.”
Location, Location, Location: The Care Setting Can Make the Difference
Effective long term services and supports delivered in the home like the ones Jeanette receives, can have a major impact on a person’s quality of life, health outcomes as well as the cost of care. In fact, LeadingAge New York recently noted that if MLTC coverage helped just 10 percent of New York State plan enrollees to avoid nursing home care, the savings would total over $1 billion. According to the New York State Department of Health’s (NYSDOH’s) 2018 Managed Long-Term Care Report, care coordination provided by MLTC plans like CHOICE appears to minimize emergency room visits as well as admissions and re-admissions to hospitals.
Plan Quality—As Told by the Numbers and by the Members
The NYSDOH’s 2018 MLTC Report also offers statistics about overall member plan satisfaction and quality of care across all insurers. The report references a survey of about 28 percent of MLTC members who had six months of continuous enrollment in 2016, among those:
· Approximately 87% rated their health plan as good or excellent
· 83% rated the helpfulness of the plan in managing their illnesses as good or excellent
· 96% of enrollees had no falls resulting in major or minor injuries in the previous 90 days
· 87% of enrollees remained stable or demonstrated improvement in Daily Living Activities
In addition, compared to many models of providing long term care services, the cost of managing this important program is relatively low and has actually declined.
But, again, metrics don’t tell the complete story. Just ask Sally, a 92-year-old resident of Bensonhurst, Brooklyn. Through the essential help of her CHOICE team, Sally is still able to continue to live independently—and tend to her prized back-yard garden. Her CHOICE home health aide, Rita, assists Sally with everything from bathing to dressing, preparing her meals, transportation to medical appointments, and acquiring medical supplies. Sally says, “Without Rita, I’d have a hard time managing. She’s my right arm.”
Sally sums up feelings that many MLTC members share: “I want to stay home,” she says. “There’s no place like home.”
