HCBS Waivers Work Best When All Stakeholders Share Data
It’s not easy for states to provide holistic Medicaid services to their citizens. Take the case of Home and Community Based Services (HCBS) waiver programs. About 4.6 million enrollees received Medicaid HCBS in 2017, with joint federal and state program spending totaling $82.7 billion. This investment—over half of all Medicaid long term care spending—allows individuals to be cared for in their homes at a lower or equal cost to that of institutional care, with the additional benefits of greater independence and better access to family and friends.
As you can imagine, there are a lot of stakeholders in HCBS programs. And because there are so many individuals and dollars involved, gaps in care can emerge and efficiencies can be lost when data lives in silos or communications break down. HCBS programs deliver the best outcomes most cost-effectively when internal and external stakeholders reference the same data simultaneously.
Sharing data for better outcomes
While the exact program structure varies from state to state, generally multiple departments and agencies are responsible for waiver program oversight, administration, and delivery of services. The greater the number of organizations involved, the more likely it is for there to be inconsistencies in how waiver requirements are applied and operationalized. Even within a single agency, different types of services may be handled by different departments.
All of these different processes can cause data silos, which in turn cause communication and information sharing problems. The lack of transparency may cause errors in determining eligibility or delays in providing services. Paradoxically, many these of these programs seek to help beneficiaries work toward self-reliance, but the sheer number of agencies and systems an individual has to navigate can make that goal especially difficult to achieve.
Given that HCBS include highly personalized services that support vulnerable individuals in key areas of their lives, it is crucial that everyone (including the participant) is on the same page regarding which services an individual is eligible for, which agencies are managing which components of overall care, and what outcomes are being reached. This requires transparent communication with all types of stakeholders, including participants, caregivers, advocates and providers.
Improving data tracking and reporting
In addition to helping all stakeholders communicate more effectively, sharing data helps agencies operate better. The use of separate systems to coordinate and administer HCBS services can lead to inefficiencies including duplication of activities across departments. In other areas the lack of automation and systems built on outdated technology can burden agency staff with manual, paper-based processes.
Separate, manual processes are very difficult to track. Data is easily lost, or stored in ways that are not consistent from agency to agency. It is hard to have a holistic view of any individual participant, get a high-level view of the entire HCBS ecosystem, or do system-wide analytics or reporting when data isn’t shared or aggregated.
Transformative technology for a holistic view
Modernized, shared technology enables agencies to share data easily, and makes it easy for key stakeholders to access information. Processes can be automated, and data can be more easily analyzed. Reporting and metrics are also easier when everyone is working from the same systems. To truly get a holistic view, the shared system must:
- Give participants access to and control of their own client records. In most cases, the person with the most insight and the most interest in making sure records are accurate is the participant receiving the services. In the interest of promoting self-reliance, the client should have access to their own data.
- Give service providers and case managers access. At the invitation of the participant, the system should give other relevant parties the ability to draw from and contribute to the data to make sure records are complete and accurate.
- Give agencies the ability to share information. Systems that limit and prevent the sharing of information about clients between organizations and data systems can hobble case managers, limit client success, and impair the state’s ability to analyze outcomes.
Updated technology gives states the flexibility to administer their waiver programs based on the needs of their target populations. They can also improve program integrity and quality control, and be more consistent in program and service delivery. Ultimately, this all leads to a better participant experience.
With the numbers of HCBS waiver participants growing, it is critical to make sure that these programs are as effective and as efficient as possible. Implementing technology for data sharing ensures better communication, improves process efficiency, and ultimately leads to better outcomes.
MicroPact solutions support HCBS programs in multiple states, providing case management and data sharing capabilities that lead to better outcomes. Contact us today to see how we can support your needs.
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- 2019 Medicaid Enterprise Systems Conference (MESC) August 19-22 Chicago, IL