Harmony For HCBS Waiver Management

Purpose-built Technology for Managed Care

Now the most relied upon long-term solutions for Government Agencies are available to Managed Care Organizations. Increasingly, states through the use of Managed Care 1915(b) waivers are turning to managed care organizations (MCOs) to administer the delivery of long-term services and supports (LTSS) to peoples with disabilities.

In its FY13 latest report, The Centers for Medicare & Medicaid Services (CMS) reported that HCBS accounted for the majority of Medicaid LTSS expenditures. Total federal and state LTSS spend was $146 billion, HCBS share was $75 billion (51.3%) a two percent increase from the previous year. This also marked the third consecutive year in which HCBS spend increased and institutional spend decreased.

Managed Care grew by 44% from $10 billion to $14.4 billion. MCO’s accounted for 9.9% of LTSS spend but due to ongoing challenges with collecting managed care data this may be a conservative estimate.

HCBS Waiver Risk Management

The maze of waivers currently in place coupled with the myriad of funding criteria poses a unique reimbursement reporting challenge for both State and MCO LTSS administered programs. Harmony for waivers is scalable to support state-wide deployments while its flexibility insures that each waiver managed, meets the programs funding reporting requirements to mitigate reimbursement denials.

The swift adoption of waivers by the states to shift to home and community-based services has also blurred the traditional organizational structure which in the past focused on a specific group rather than a ubiquitous view across the entire LTSS spectrum of peoples with disabilities. The challenge for LTSS payers to stay ahead of the curve is to develop longitudinal metrics to measure outcomes in order to discern which programs yield the best results.

Quickly Integrate Into the Long-Term Care Ecosystem

The fixed-price-per-enrollee model offered to the MCOs allows states to better budget and manage previously variable and rapidly escalating expenses. Private MCOs run the risk that they may not be able to coordinate care at a profit. MCOs typically have deep experience and strong information systems related to the delivery of traditional healthcare. However, HCBS LTSS models require a very different kind of domain knowledge and automation technology due to the unique service types and different provider networks that deliver support outside of an institutional setting.

Mediware’s proven Harmony solutions are woven into the fabric of this nations’s care delivery network. Over forty state-wide agencies and more than half of the agencies in the national aging network use Harmony solutions every day to deliver LTSS services. Our applications enable MCOs to more effectively manage their long-term care operations through direct interaction and collaboration with agencies and providers.

For more information about HCBS Managed Care complete and submit the form to download the product brochure!

Managed Care for Behavioral Health

Now you can bring together all the diverse functions of your Managed Care Organization under one behavioral health system. AlphaMCS tracks member demographics, provider performance, applications and contracts etc.. and this all in one end-to-end solution is also fully integrated with AlphaFlex our provider behavioral health solution.

To find out more about our behavioral health managed care solution click here

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