DISCLAIMER: CoC (Continuum of Care) is an alternative term for LTSS (Long Term Services and Support). Please note that not all instances of LTSS have been transitioned to the new designation.
Continuum of Care (CoC) services, sometimes also called long-term-care, include everything from nursing home care to community-based supports such as help with chores, personal care, transportation and maintaining a home. These services are essential to help Medicaid beneficiaries, especially seniors and people with disabilities, live with dignity and as much independence and community participation as possible. For people with severe illnesses or disabilities, robust CoC services focused on personal needs and preferences can spell the difference between barely surviving and thriving.
As people are now living longer and the aging population is increasing, the demand for Long Term Services and Supports has grown. There are several components Crucial to the success of an CoC program:
Care Coordination Protocols for Shared Participants. Team management is a team based, patient centered approach designed to assist patients and their support systems in managing medical conditions more effectively. This includes making arrangements for, communicating with and monitoring between medical, behavioral health, long term care providers. Care-service coordination tasks among providers, agencies and individuals include:
1. Identification of shared clients among providers and agencies.
2. Understanding of individual and shared responsibilities
3. Prioritization of tasks and patient need; medical, behavioral, social.
4. Sharing information on each organization’s knowledge of and experience with clients essential to the health and welfare of each client.
5. Coordination of scheduled meetings and contact information and preferences sharing date to the extent feasible.
6. Engaging families and advocates as needed. Assigning care managers from organizations as needed and designating one designated “go to person”, so that the client does not need to need to be managed by multiple care managers.
7. Regular contact between providers, agencies and consumers/families
8. Agreement on shared support functions. Making referrals to appropriate providers of specific services, including transportation support.
By leveraging the utilization of services in a sustainable manor, programs can increase efficiency across operations by eliminating duplication. A lot of programs are funded by different agencies. Each has different requirements for funding. Elder services and Community Health Reps funded through IHS, in home chore services funded through the Older Americans Act. By leveraging personnel thru the clinic, services can be paid for by IHS funding if the patient is not covered by Medicaid, Medicare, private insurance etc…
Select appropriate funding stream
Different programs were set up in silos initially by the government 30-40 years ago. Silos no longer work well, now there is some overlap in duplication of services. Service silos are accustomed to their own programs. These programs need to move past silos and understand other programs better. Management needs to support this.
The lack of knowledge about the benefits of doing this and lack of knowledge of other programs and how they work. Fear and lack of trust, i.e. I don’t have to share that information, you don’t need that information. These are all roadblocks to creating a successful CoC program and inability to work towards best practices in billing third party revenue. As long as programs operate in silos, there is no ability to bill anyone else such as Medicaid, VA, Private Insurance. In short, programs can split staff salaries across different programs so part comes out of clinic for the purposes of funding.
Resource Streams
Different funding agencies have different reporting measures.
It is important to try and capture as much third-party revenue from outside the tribe as possible to offset tribal contribution.
Utilize seed money: some money through various pilot projects
Leveraging personnel. At the core of this is money.
Use matrix management to utilize same person in elder services to see same clients, and personnel eligible for assistance. Elder services staff can be split between the clinic and elder service by incorporating this into their job description thus making the staff persons services Medicaid billable. In order to achieve this, HR and Tribal Council need to be onboard.
Programs can pay for medical supplies thru federal contracts utilized by clinics. Federal Supply Schedules “FSS” also a good funding source for supplies.
Trans American equipment is free. The Federal Government already bought equipment so when it is no longer needed, it is shipped to a warehouse to be stored. These supplies are already purchased through the federal government, sometimes they are new, other times they are used. The catch is, when you receive what ever equipment you requested it is in AS IS status. Sometimes the equipment is in good working order, other times it needs repairs.
Go in together with other tribal programs to buy in bulk therefore getting a discount due to quantity purchased.
Leverage facilities: Example; share kitchens with senior center, nursing facilities etc.. to save costs. Utilize empty space in facilities such as the VA or Senior Center if available.
The size of the Tribe, number of services, management support, dealing with silos, communication and trust, resources, people available and how well programs can utilize technology to assist and accelerate efforts will determine how long it will take to make progress in building Continuum of Care services.
Incorporating care coordination, staff alignment, purchasing power and space sharing will help save costs, and expand CoC services thus generating more third-party revenue which will assist in program sustainability.
