What Health Plans Can Learn from Community First Choice Options

Mounting data shows us that non-skilled in-home care is not only wanted by seniors, it’s needed. To meet this need, the state of Maryland has built a Medicaid “Community First Choice (CFC) Option” program. CFC options allow “States to provide home and community-based attendant services and supports to eligible Medicaid enrollees under their State Plan.”¹ Not dissimilar from our own mission at CareLinx, the goal of these programs is to ensure members can “accomplish everyday tasks [of living] for themselves.”² Maryland’s program is worth paying attention to, as its’ success illustrates many of the challenges health plans will face in implementing the same benefits.  In 2016, AARP found that “40 percent of CFC enrollees were adults 65 and older, and that 55 percent were people with disabilities under age 65.”³  CFC options, the buzz around home care, and CMS benefit changes that impact health plans and systems, all point to the same thing: how critical it is for health plans to cover non-skilled home care services. That means health plans need to keep a competitive edge by meeting the home care needs of their members now. To do that effectively, they’ll need to think about scale and measurement.  

The Problem of Scaling Long Term Service and Supports (LTSS) and Home Care Services

The population of those needing LTSS and home care is naturally becoming larger and more diverse in parallel with the general population. That means we’ll see race, ethnicity, and cultural backgrounds taking on greater meaning in all kinds of care programs  To be successful in reaching these audiences, leading home care providers will need to be scalable nationwide. Although the state of Maryland chose to invest a large amount of money, time, and resources into developing a qualified group of home caregivers, for health plans, it’s not practical to attempt building a solution like this in-house. It will take a national-level, personal attendant workforce to meet these challenges.  

Time and Quality Tracking in Home Care

Another concept that can be overwhelming to health plans that are taking on home care services, is the administrative burden. It goes beyond program set-up, management, accessibility, and offerings that need to take language and cultural barriers into account. Effective home care programs require advanced methods of thorough time-tracking and quality assurance measurement. Many health plans wanting to improve customer experiences while ensuring CMS compliance in the home care space will struggle to create these necessary systems and technology. They need quickly adoptable platforms that offer up detailed data that gives them better access and control over their senior members.  

Bundled Home Care Solutions and Services for Health Plans

There are alternatives to building and maintaining in-home services “in-house.” The best option is for health plans to partner with home care providers to improve offerings and drive sustainable income. Unfortunately, not all home care providers offer tech-based approaches and a nationwide pool of qualified caregivers. Health plans should be wary of home care providers who don’t offer clear ways to scale or have established systems that relieve the administrative burdens of effective home care.  That’s not all. Here’s what else health plans need to know before choosing a home care partner.