Decision Support for LTSS & Post Acute

Community-based long term services & supports (LTSS), facility-based long term care (LTC), and post acute care (PAC) together represent over 25% of spending in Medicaid-Medicare populations.   Fueled by the reduction of inpatient stays, the growth of independent living and aging-in-place, and State efforts at “rebalancing” long term care, the cost of these community-based services is growing 6%-10% annually—more than twice as fast as any other service type.

Despite the dramatic growth trend in community Services, payers and providers have few decision support tools for benchmarking, cost containment, value-based pricing, program integrity, and measurement of quality, outcomes and consumer satisfaction.

Caremetrics is developing a national database of LTSS and PAC experience, building on traditional functional assessment tools such as Minimum Data Set (MDS), Supports Intensity Scale (SIS) and time-for-task calculators to develop a new generation of evidence-based performance guidelines and metrics for use by UM and Medical management teams. 

We help our clients design and launch utilization studies, specialized cost containment campaigns, quality performance programs, and shared savings partnerships.

Health plan provider network and medical management teams use our solutions to enhance the quality and efficiency of their network providers.

Our evidence-based decision support tools focus on:

  • Behavioral Health
  • Home health and home care
  • Consumer self-directed care
  • Personal care assistance
  • Nursing and skilled nursing facilities
  • Non-emergency transportation
  • Post-Acute and Rehabilitation
  • Adult day health, family care
  • Adult foster care
  • DME, assistive/adaptive technology, environmental modifications