Taking technology to a higher level, a pair of experts in the Medicaid services arena captured a
vision of the near-future for attendees at Tellus’ 2nd annual national EVV forum with a bold
prediction: your zip code will dictate your future health outcomes more than your genetic code.
“There is a lot of information now that correlate the social setting, the living conditions, the
education and family history that you have to health outcomes,” said Charles Mosier,
Enterprise Architect at Optum.
Current market trends in the managed care space was the subject of a panel discussion June 13
moderated by Lia Sweeney, Tellus EVP of Strategy, and presented by Mosier and Alex Shekhdar,
a Medicaid thought leader and Principal of Sycamore Creek Health.
A growing subsector of Long-Term Services and Support (LTSS), Medicaid Managed Long-Term
Services and Support (MLTSS), is a patchwork of different services providing home health care
benefits that, through Electronic Visit Verification (EVV), validate services for CMS and the federal government from both a fraud and beneficiary standpoint, according to Shekhdar. They are the driver behind legislation for home health services, he said.
“That’s where EVV comes in,” he said.
While people in certain zip codes with higher incidences of poverty have difficulty getting out of
those situations, “[location] also has impacts on nutrition, exercise and on availability of
transportation. All of those things have a much broader impact on health outcomes, more so
than some of the things being done from a clinical perspective,” said Mosier.
Within MLTSS, the bigger question, according to Mosier, is how to address those conditions
that beneficiaries have in addition to the clinical pieces that are part of the overall health
In the personal care and home care space, caregivers are often trusted at a higher level, even
over nursing providers or the care coordinator, Mosier said, noting a growing focus by the
industry on socialization and the impacts of loneliness and isolation on the beneficiary.
“They trust that person because they see them all the time,” said Mosier.
Pieces of information need to be collected, analyzed, reevaluated and “turned into improved
ways of measuring what’s actually happening so we can improve as we go through the process
of migrating from individual fee-for-service models to a more holistic model,” said Tellus’
From a technology perspective, there are a number of amazing data collection devices out
there, said Mosier, noting the biggest challenge is leveraging technology available now, and in
the future, to collect the data so it can be used.
When Mosier looked at EVV, he noted up to seven data elements.
“The ability to capture all that data and coordinate it with all the other [claims] information we
are getting is an untapped resource leading to the ability to be proactive with these [Medicaid]
beneficiaries,” he said.
Capturing data in the home
The critical component of EVV is the person in the home, and EVV’s ability to evolve that data
captured in the home, Shekhdar said.
With personal care workers, EVV needs to go beyond referrals to know at the point of service
“what’s happening and to communicate that up the chain,” he said.
A crossover of clinical services delivered is evolving to “what are we doing to capture all the
other social determinants of health needs.”
Shekhdar sees the impact of EVV supporting LTSS as critically important to proactively inform
what has to happen in the overall plan of care.
“I’m really understanding at the point of service in that person’s home what’s happening right
now,” he said.
Sweeney also extolled additional applications of EVV for long-term services in the consumer-
directed model, a growing segment in personal care delivery.
“Our application does have the ability for the caregiver to begin a service without a schedule
entered into the application so the caregiver can start the service when they actually begin
care,” she said. “A lot of cases in the consumer-directed model is that the caregiver doesn’t
have a formal schedule, they live there. We have introduced that function.”
Medicaid spending for MLTSS more than doubled between 2012 and 2015, according to the
most recent data collected and released by Medicaid.gov in 2018. That number is expected to
increase as states implement new programs, the agency said.