MLTSS Toolkit – Resources

Performance Metrics and Measures:

CAHPS Measures

Community-based Care Transitions Program (CCTP):

QualityNET
MedPAC

Health Outcomes Survey (“HOS”)

HEDIS Measures

Hospital value-based purchasing:

CMS
Kaiser

Medicare Advantage Plan Star Ratings:

CMS
Kaiser

Medicare (ACO) Shared Savings Program

Quality Measures: State dual demo programs (Commonwealth Fund)

Definitions:

Evidence-based:  The term “evidence-based” is used frequently by CBOs, MCOs, and policymakers.  But what does the term really mean?  Does everyone share the same definition?  Click the link for an insightful Health Affairs article on the subject.

Payers:  Organizations who pay for vended services.  For our purposes, these are typically managed care companies, hospitals or employers who pay the CBO to deliver specified programs or services.

Vended Services:  For purposes of this Toolkit, we will use the term “vended services” when referring to an arrangement under which a CBO contracts with an entity (managed care company, hospital, employer, etc.) where your CBO agrees to provide specified services to a distinct population in return for specific compensation or reimbursement from the payer.

Abbreviations and Acronyms:

AAA:  Area Agency on Aging

ACL:  Administration for Community Living (Dept. of HHS)

ACO:  Accountable Care Organization

ADRC:  Aging and Disability Resource Center

AHRQ:  Agency for Healthcare Research and Quality

ALF:  Assisted Living Facility

CAHPS:  Consumer Assessment of Healthcare Providers and Systems

CBO:  Community Based Organization (AAA, ADRC, CIL, etc.)

CIL:  Center for Independent Living

CMS:  Centers for Medicare and Medicaid Services (Dept. of HHS)

FFS:  Fee-For-Service

HCBS:  Home and Community-Based Services

HEDIS:  Healthcare Effectiveness Data and Information Set

HHS:  U.S. Department of Health and Human Services

HOS:  Health Outcomes Survey

HVBP:  Hospital Value-Based Purchasing

LOC:  Level of Care

LTSS:  Long-Term Services and Supports

MA:  Medicare Advantage

MCO:  Managed Care Organization

MLTSS:  Managed LTSS

NCQA:  National Committee for Quality Assurance

PERS:  Personal Emergency Response System

SNP:  Special Needs Plan

Stars:  CMS rating system for Medicare Advantage plans

Readings:

Competitor Assessments: Porter Generic Strategy Model; Competitive Strategy: Techniques for Analyzing Industries and Competitors, Porter, Michael E., New York Free Press.  (Available through your favorite book seller).  This is one of several readings that may help CBO leaders in their market/competitor assessment and how to position their CBO and its programs and services for success in a competitive landscape.

Dual Eligible Beneficiaries of Medicare and Medicaid: Congressional Budget Office report:  This CBO report analyzes the dual eligible population and why state and federal policymakers are focused on bringing managed care practices to this population.  This report provides the CBO with an inside look at the motivations driving coverage changes for this population and can lead the CBO toward identification of program and service offerings that may deliver value toward addressing these policy objectives.

Pricing/cost resources (SCAN Foundation):  An excellent resource of pricing considerations.  Note that the A/D Partnership is also developing a module for this toolkit on pricing that will be available in early Fall 2014.

MLTSS Webinar Archives (A/D Partnership):  This is the hub for a series of A/D Partnership webinars on business acumen.  It includes archives of webinars on quality and performance measures, legal considerations, and development of service packages.  As new webinars are archived, a link will be posted on this page.

n4a Business Planning Considerations:  This document provides a series of organizational considerations your CBO should review as you plan for and develop products and services.

Tools:

ACL CBO Self-Assessment Tool:  This is a detailed self assessment tool on the contracting cycle from pre-assessment through the contracting phase.

n4a Self-Assessment Tool:  This self-assessment tool focuses on products and services to help the CBO take a thumb-nail picture of what products and services might be the organization’s most advantageous offerings.  It is a snapshot and not intended to produce a final plan.  Rather, it will help CBO leaders to make an initial force-rank assessment from which the organization can explore and refine.  This tool is designed to complement the ACL CBO Self-Assessment Tool above.

n4a “Elevator Speech” Tool:  After completion of the self-assessments above, use this tool to refine your talking points on one of your priority products and services in preparation for discussions with a potential business partner (hospital, ACO, MCO, etc.).  The purpose is to lead the CBO leader through a series of questions and answers and finally, the development of a value-based, to-the-point “elevator speech” for use in discussions with your potential business partner(s).