It has been accepted that effective home and community-based services (HCBS) are essential to drive down unnecessary acute utilization and institutional care while improving patient and family outcomes. But how do you know if the HCBS at play for your patients are effective? CMS has released the HCBS quality set, which is currently voluntary but may become mandatory, especially in innovative pilot programming coming out of CMMI. This HCBS quality set aims at building access, rebalancing spend between institutional care and HCBS, and integrating patients into all aspects of society.
The HCBS quality set includes quality measures from a wide variety of sources. First is HCBS CAHPS Survey which has been endorsed by the National Quality Forum and includes 19 quality measures over 11 domains such as service delivery and effectiveness, workforce, system performance and accountability, and caregiver support. Next is the National Core Indicators which assess key indicators related to community living and which have already been adopted by 48 states. Another is the Personal Outcome Measures which assess the care experiences of high-need populations including older adults, adults with disabilities and others. The last is the Quality Measures for Managed LTSS which CMS developed for managed care organizations. There are four of these measures that have HEDIS equivalents and four without, and all eight examine assessment and care planning processes as well as rebalancing. All measures are accessible through the source material listed below.
Once the quality metrics are set, operational protocols must be established that adopt a quality rating system, collect data from staff, conduct patient and caregiver surveys, and compare the service plan to service performance. In addition, attention must be given to how providers will be monitored and incentivized to maximize HCBS quality. This may be integrated into value-based reporting and incentive structures along with other quality measures. Lastly, an incident reporting and management system should be established to identify extreme threats to patient safety and well-being, including abuse, hospitalizations, medication errors, or other events that involve or risk harm to patients. Knowing that HCBS are essential for positive patient outcomes for a community-based healthcare continuum, leaving HCBS quality unmonitored makes no sense. Now there is a structure in place to accomplish the quality assurance that you need.
“Measuring Quality in Home and Community-Based Services (HCBS): Key Considerations for Health Plans” by Resources for Integrated Care, released on December 2, 2022 and available at https://www.resourcesforintegratedcare.com/wp-content/uploads/2022/12/Measuring-Quality-in-Home-and-Community-Based-Services-HCBS-Key-Considerations-for-Health-Plans.pdf