in-home supports assurance system overview

In-Home Supports Assurance System (ISAS)John WilsonWhitney Moyer

Introduction• In-home Support Assurance System (ISAS)

▫ Phone Based Billing System for in-home personal care providers

• Purpose▫ Simplify billing▫ Monitor provision of services

• Process▫ Provider calls ISAS to clock in/out▫ Calls matched with provider, participant, and Plan of Care▫ Claims automatically generated▫ All claims are processed on a weekly basis

Background System Benefits Lessons Future

Background• Why ISAS?

▫ Recommendations from compliance report done by Lewin (Dec. 2010)

▫ Goals of Report: Decrease improper in-home personal care provider payments Maintain and improve quality of care delivered Limit burden on participants

• Current in-home personal care expenditures▫ See Figures 1.1 and 1.2 on following slides

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Figure 1.1 Distribution of Personal Care, Attendant Care, and State Plan Personal Care Services Users and Expenditures, FY 2011

Participants = 10,315 Total Expenditures = ~ $128,500,000

$66.1 52%

$32.6 25%

Living at Home, 965

10%

2,39823%

State Plan Personal

Care, 6,95267%

State Plan,$29.823%

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Figure 1.2 ISAS estimated to save 8-9% of total expenditures

Total Expenditures = $128,500,000 Estimated Total Expenditure under ISAS = $118,220,000

Estimated Savings (8%) = - $10,280,000

Living at Home, 965, 10%

2,398, 23% State Plan Personal

Care, 6,952, 67% $66.1, 52%

$32.6, 25%

$29.8, 23%

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Background Cont’d• States with Similar System

▫ South Carolina, Oklahoma and Tennessee

• Model Used▫ South Carolina implemented a similar system years ago and

achieved a 10% savings in claims reimbursement at a program cost of 1-2%

Background System Benefits Lessons Future

Provider Setup• General Identification

▫ Name, NPI, SSN

• Voice Recognition▫ Required for all provider calls▫ Providers uses same phrase▫ Authenticate providers

• One Time Password (OTP)▫ Only needed when provider calling from non-participant

phone▫ Keychain sized device▫ Randomly generated number▫ Number changes every minute ▫ Numbers traced to a specific timeBackground System Benefits Lessons Future

Provider Setup Cont’d• Training

▫ In-Person Training Regional sessions available statewide

▫ Webinars www.ltsstraining.org

▫ DVDs Requested by calling the Help Desk

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Claims and Reports• Claims

▫ Nightly Process▫ Ability to View Claims▫ Ability to Adjust Claims

• Reports▫ Service-based reports▫ Claim-based reports

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Exceptions• Exceptions

▫ ISAS creates exceptions for inconsistencies Example exceptions: missing clock-in/out, participant ineligible,

inactive POC, etc.

▫ ISAS staff on-site and staffed within OHS Coordinates with program staff to handle exceptions workflow

Policy & Compliance, LAH, WOA, MAPC, MDoA and eventually CFC

More proactive approach to handling claims issues

▫ ISAS staff can resolve certain inconsistencies before claims generated Identify fraud Retraining needs Gaps in services

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Exceptions Data• ISAS staff will use exceptions data to:

▫ Ensure providers servicing participants appropriately▫ Ensure claims accurate▫ Proactively handle claims issues▫ Process claims more efficiently▫ Track all steps of claims process and resolution

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Help Desk• Offsite and vendor staffed

▫ Register providers for ISAS▫ Answer provider technical issues and requests

• Providers directed to Help Desk after three failed clock in/out attempts

• Live operator hours: ▫ 6 a.m. – 8 p.m., Monday-Friday

• Outside of live operator hours: ▫ Providers are prompted to leave necessary information via

voicemail

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Benefits

• More efficient billing▫ Daily claims and weekly processing

• Provider accountability▫ Participants want greater provider oversight

• Faster communication▫ Emailing directly with all agency providers, and most

independent providers

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Benefits Cont’d

• Department oversight▫ For the first time, Department will know agency staff

providers’: Names

Social Security Numbers

Voiceprints 4,976 agency staff currently using ISAS

▫ Greater compliance Agency provider staff turnover, provider retraining and

corrective actions

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Current Stats• Calls

▫ 5,500 (approx.) clock ins and outs per day▫ 98% (approx.) calls go through automated system without

live operator assistance

• Plans of Care▫ 927 POCs updated since July 15 launch

• Users▫ 4,976 agency staff currently using ISAS▫ 1,000+ ISAS users trained

Includes: Case Managers, Agency Administrators, LAH Independent Providers, OHS staff

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Lessons Learned• Misconceptions

▫ Providers billing inappropriately for travel, shopping and time spent waiting without participant

▫ “Big Brother”

• Culture Change▫ Examples:

Participants – “From personal companionship to personal care” DHMH – “All hands on deck” Family Providers – “From a helping hand to a job”

• Buy-In▫ Better communication with our stakeholders, including

provider union, participants, providers, and even within DHMH itself

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Lessons Learned Cont’d• System Readiness

▫ Clean data▫ Implement program in phases

LAH/WOA Agencies LAH Independents WOA Independents MAPC

Dual-billing ▫ Ensure that short term fixes do not lead to long term problems

E.g. Softening voiceprint More providers entering SSN

• Go-Live Readiness▫ Issues/Findings

More transparent metrics for assessing launch readiness More viable plan to reach the deployment date Better identify backup plan

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Lessons Learned Cont’d• Go-Live Readiness Action Items

▫ Metrics Measure staffing, known issues, and expected call volume

▫ Viable Plan Develop deployment plan of important milestones before going

live Identify external dependencies that are not in vendor/DHMH

control (e.g. integration with MMIS) Setup vendor/DHMH meeting to make final go-live decision

▫ Backup Plan Develop key failure scenarios and develop backup plans Identify process for making plans effective

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Future Potential• Baseline for quality measures

▫ Change from simple timesheet data to detailed data

• Plans of Care▫ More accurate and standard information▫ Standard plans can help improve care

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Questions?

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