The U.S. health care system continues to evolve in favor of value-based care, and this shift also extends to human services organizations. The mission of value-based care is to provide value, quality, and accountability for outcomes, while controlling costs and increasing efficiency. Because health care and human services are both responsible for people’s overall health and well-being, value-based care has applications across the entire continuum of care, and coordination between the two will generate better results.
Health systems are investing billions in modernizing their data systems, transitioning to electronic medical records, and developing patient portals to improve health care for all Americans — especially for patients who receive Medicare and Medicaid services. But health systems primarily focus on the clinical environment.
After it was passed in 2018, the CHRONIC Care Act (CCA) caused a seismic shift in how Medicare Advantage (MA) plans coordinate care for members by expanding non-medical services and support to the more than 12 million chronically ill people in the United States. The goal is to help prevent further decline in health and improve care coordination across medical and non-medical home and community-based services (HCBS).
The ongoing trend toward value-based care and quality management increases the importance of data. To succeed in this environment of integrated care across the continuum of acute, post-acute, and home- and community-based services, organizations must demonstrate quality programs and achieve positive outcomes. It’s no accident that quality, outcomes, and results are all a part of the CCA.
Community-based organizations (CBOs), HCBS organizations, state agencies on aging, and others in the aging and disability network must all become familiar with the CCA and start having conversations with MA plans.
The CCA raises several significant questions that state policymakers must address, including:
- How can we coordinate across MA and HCBS services?
- What are the differences between how CMS and states define services for the CCA?
- What opportunities for cross-organization coordination do we have, including working with the Medicare-Medicaid Coordination Office and Medicaid managed care organizations (MCOs)?
There’s no doubt that the CCA calls for increased collaboration, and community-based organizations can leverage the CCA as an opportunity to expand the reach of their services and help even more people.
Want even more information about how the CHRONIC Care Act affects community-based organizations? Download this new white paper by industry thought leader Dr. Jay Bulot to learn more about the CCA and how to integrate Dual-eligible special needs plans (D-SNP), fee-for-service (Medicare and private pay), and Medicaid-Managed LTSS: The Promise and Potential of the CHRONIC Care Act for Community-Based Agencies.