The National Committee for Quality Assurance, which measures health plan performance data through its HEDIS tool to enable comparisons between insurers, is getting ready to start assessing the quality of long-term care services covered by payers, primarily state Medicaid agencies.
States are looking to move long-term care services to managed care plans, says Raena Akin-Deko, assistant vice president for product development at NCQA. “We’re looking to improve the quality of care for vulnerable populations to remain independent in their home and community,” she adds.
The new accreditation program also will cover Area Agencies on Aging, Aging and Disability Resource Centers in states and territories, and other case management organizations, including hospitals and larger group practices.
NCQA spent much of 2015 and part of this year talking with insurers, long-term care providers, consumer advocates and policy experts as it drafted proposed standards for a new long-term care accreditation program, with its proposals available online and a comment period in effect until March 23.
The goal is to have the program ready in July, when organizations ready to seek accreditation can immediately apply, while others can apply later when they are ready. Services that will be assessed for their quality include helping individuals go shopping, bill paying and toileting, among others.
Core standards for the long-term care support program include:
Institute person-centered care planning. The individual using care and services controls activities surrounding care processes, meaning the individual is actively engaged in the process.
Manage care transitions. Organizations have a process to effectively manage transitions, support individuals during transitions and reduce unplanned transitions.
Use of a critical incident management system. Organizations have a dedicated system to promptly report, track and follow-up on incidents such as abuse, neglect and exploitation.
Coordinate services. Care and services are coordinated for individuals who have complex needs and multiple providers, and care gaps are closed.
Set qualifications for providers. Organizations set and verify qualifications and provide training and support to home- and community-based service providers.
Transition requirements when patients move from the home to the hospital, and then back home will be a major factor in the data reporting process, according to Akin-Deko. NCQA wants to measure whether treatment plans are communicated to appropriate providers during transitions and if patients are involved in the process to be aware of all aspects of a care transition. That includes, for instance, assessing follow-up processes after discharge to ensure new prescriptions are picked up and the patient knows how to take the medications.
Akin-Deko also urges healthcare consumers and professionals across the long-term care spectrum to access “Medicaid and Long-Term Services and Supports: A Primer,” from the Kaiser Family Foundation and available here.
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