In the world of Managed Long-Term Services and Supports (MLTSS), accurate functional assessments that reflect true member acuity are the cornerstone of quality care. These assessments serve as the foundation for creating individualized care plans that address the unique needs of each member.
Capturing truly accurate assessments can be a significant challenge. Unpredictable working conditions, members who are sometimes unable to convey their needs, and limited time frames can hinder the process. In addition, most plans conduct assessments in traditional care management platforms that aren’t designed to be efficient for home and community-based services and have a limited emphasis on improving assessment accuracy.
These combined factors can limit a clinical team’s ability to ensure the precision needed to determine optimal care. However, with the right technology solutions that prioritize assessment accuracy, clinical teams can authorize the most appropriate amount of care needed, improving health outcomes, and enhancing each member’s overall quality of life.
The Role of Comprehensive Health Assessments
Functional assessments are a critical component of the assessment process in MLTSS (along with other NCQA-required elements, like cognitive, medical, and social assessments). These assessments focus on evaluating an individual's ability to perform activities of daily living (ADLs) and instrumental activities of daily living (IADLs). Knowing a member’s functional limitations, clinical teams can help ensure each member receives the care they need to achieve their desired level of independence.
Ensuring functional assessments are accurate is essential for effective resource allocation and improved health outcomes. Below are several results from having accurate or inaccurate assessments:
An inaccurate assessment can underestimate a member’s care requirements by excluding services for IADL/ADL tasks that are functionally related. For example, getting dressed and bathing have similar physical demands, such as lower body stability, strength, and range of motion. If a member indicates to an assessor that they need help dressing, but do not need help bathing, this may represent inconsistent functional needs that an assessor may want to re-examine. Ignoring this inconsistency could result in under-authorizing care minutes for the member, which could lead to a preventable accident, like falling in the tub while attempting to bathe unassisted. This not only leads to short and long-term costs for a plan (hospitalization) but also will likely worsen long-term health outcomes.
In contrast, an accurate assessment identifies the need for functional support across all related IADL/ADLs, ensuring a member receives the care minutes that are required. This ultimately improves the member's well-being and independence, reduces hospital visits, and leads to better health outcomes and more predictable costs.
Ensuring Accuracy in Assessments
Several key factors can dramatically improve the accuracy of assessments:
- Software to Analyze Member Responses: Software products that analyze member responses to identify potential clinical inconsistencies can ensure consistency and reliability in the assessment process.
- Assessors Trained on Plan-Wide Standards: Assessors must all be trained and operate under the same standards to reduce unnecessary variability across a plan’s member base.
- Interdisciplinary Collaboration: Deep collaboration among care managers and supervisors helps create a complete picture of a member's needs.
Accurate assessments require a commitment to continuous operational improvement. As healthcare evolves, adopting technologies is essential to maintaining high standards. By prioritizing assessment accuracy, a plan can ensure members receive better health outcomes while ensuring efficient resource allocation.
Key Takeaways:
- Accurate assessments are essential for delivering person-centered care in MLTSS.
- Functional assessments are critical in understanding a member's needs and capabilities.
- Key factors to improve accuracy include software to analyze member responses, assessors trained on plan-wide standards, and interdisciplinary collaboration.
- Committing to quality in assessments is an ongoing process requiring continuous improvement.