In 2021, Alene Shaheed found herself in a desperate situation.
The 76-year-old living in Florida has used a wheelchair since her spinal surgery in 2017. Despite her physical limitations, she has had a good life in her home in Jacksonville, enjoying her hobbies and time with friends. This is largely due to professional home health aides assisting with the physical tasks of daily life, including cooking, cleaning the house and taking care of her body, according to a recent interview with the New York Times.
But a year into the COVID-19 pandemic, things were looking dire. In the same New York Times interview, Alene spoke about the dangerous impact staffing shortages had on her health. “If no one comes for three days, I don’t get a bath for three days…I don’t have anyone to fix meals, so I’m eating ramen noodles until someone gets there,” she said.
Adequate care is not just about having access to providers. Even when staffing levels are at their optimal level for home- and community-based services (HCBS), the quality of services needs to be measured to ensure members like Alene get the care they need and deserve.
To determine whether a member is receiving what they need in their home, the Centers for Medicare & Medicaid Services (CMS) created a Quality Measure Set (QMS). State and local agencies can use the QMS to understand the impact of services they provide or oversee, demonstrate the benefit of HCBS for their clients objectively and, potentially, encourage greater funding for HCBS programs.
How it Works: QMS Centers Member Experiences
The private nature of HCBS has meant services are subject to less oversight than care in facilities. Poorly executed HCBS can result in unnoticed suffering and harm for members, sometimes due to intentional abuse or fraud. Other times, members may not get the care and services they need because caregivers lack necessary information or suffer from caregiver burnout—a phenomenon where a caregiver cannot provide services because they struggle to meet their own physical and mental health needs.
The QMS empowers Medicaid agencies to better compare and understand the factors driving successful HCBS outcomes. The QMS is meant to be precise enough that programs can use it to pinpoint specific factors that elevate or reduce the quality of home-based care from an agency. Thus, agencies can use the QMS to assess and improve the quality of their services.
CMS has released the technical requirements for each QMS standard, and broke them into three categories:
- person-centered assessments and care plans
- person-reported outcomes
- measures of long-term services and supports (LTSS) rebalancing
CMS details each of their quality measures in easy-to-read briefs. The assessments empower Medicaid members to define what quality means to them, and describe their experiences wholistically, while also maintaining a clinical outcome-based metric of quality.
How We Can Help
At FEI, we know analysis of services leads to better member outcomes because with a clear picture of how services are impacting members, agencies can make better decisions. But conducting these types of reviews can also become an additional burden on agencies overseeing care.
Fortunately, our enterprise technology solutions can dramatically alleviate that burden. FEI’s Blue Compass case management platform for LTSS/HCBS is a modular, web-based application that empowers our customers to automatically capture, update, and maintain client services data in one virtual space.
