When creating an effective service plan for a member, care managers are responsible for determining the optimal allocation of time and resources. In a capitated model, there is a fixed budget for an entire population, striking the right balance is essential. Providing too few hours can lead to unmet needs and poor health outcomes while over-allocating hours to someone who may not need them can unintentionally create discrepancies. Doing so may limit the availability of services for members with greater needs, as the plan must remain within its overall capitation budget.
Health plans commonly use two primary approaches to build service plans: task-level and rules-based time allocations. Understanding the advantages and limitations of each approach is vital for clinical operations to ensure members receive the care they need to live in their homes or the community.
Task-Level Time Allocations
A task-level approach to service planning involves breaking down a service plan into task-level requirements and assigning time units to each individual task. Rather than focusing solely on standardized categories like ADLs and IADLs, this approach encourages care managers to have a person-centered conversation with each member to understand their unique circumstances, preferences, and support needs. By tailoring the plan based on the individual’s goals and daily routines, care managers can create a more accurate service plan that truly reflects and supports the member’s overall health.
Rules-Based Time Allocations
On the other hand, rules-based time allocations involve approving a pre-specified range of time for a service plan without allocating that time to individual tasks. While this approach may save time and ensure each plan stays within its capitation budget, it often comes at the expense of keeping the member at the center of the service plan. Care managers may have limited flexibility to prioritize more cost-effective Home and Community-Based Services (HCBS), such as home-delivered meals, occupational therapy, or home modifications. All of which can reduce the total cost of care while supporting better member outcomes. Leveraging these resources is increasingly important as Medicaid budgets are under pressure and the demand for HCBS continues to rise due to an aging population. With a limited supply of paid formal caregivers, integrating informal supports and cost-effective services into care planning isn’t just beneficial—it’s essential to delivering sustainable, high-quality care that keeps the member at the center.
While task-level time allocations provide superior accuracy and ensure person-centered care, not all states and plans have adapted to this more member-acuity-focused approach. Without the proper technology, rules-based time allocations may seem an easier and better option in the short term. However, achieving high-quality care and meeting each member's unique needs should always remain the ultimate goal.
At QCSS Health, we’ve created a solution to address the challenges of implementing a task-level approach head-on with our Time-Tasking Validator. This solution simplifies the creation and management of task-level plans, reducing complexity while improving accuracy and efficiency, and ensuring consistency with the health information collected through the comprehensive assessment.
Key Features of Time-Tasking Validator:
- Automatic Translation from Comprehensive Assessment: Responses from the completed comprehensive assessment are automatically translated to the Time Tasking form, pre-populating 80% of responses and reducing administrative burden.
- Alignment with Clinical Guidelines: Ability to apply both default and min/max time allocation guardrails for each task based on acuity (derived from an aggregation of published state-based standards).
- Cost Estimation: Provides clear insights into service costs for better resource management.
- Precise Resource Allocation: Sets clear minimum and maximum limits for tasks and time, scaling time allocation based on assessed performance and capacity to ensure consistency and accuracy. Care can be provided outside the bounds of this precise allocation when a care manager escalates their request.
- Streamline Utilization Management (UM) Review: Focus the UM Review process on true outliers and shorten the time to finalize each assessment. Provide real-time insight and feedback on requests for additional time. Enhancing visibility into requests that may not be fully aligned with the member's needs. This added transparency supports more informed decision-making and provides a more efficient, person-centered workflow.
With the Time-Tasking Validator, clinical and UM teams can seamlessly implement task-level plans and balance precision with ease of use. This ensures members receive the care they need while plans retain oversight over hours authorized to maintain operational efficiency.