Improving Quality Measurement and e-Health in Medicaid Home- and Community-Based Services: The TEFT Demonstration

Many Americans with personal care needs receive services in their own homes to help them with daily tasks such as bathing, dressing and meal preparation. But the quality of care provided in private homes often is not measured.

The medical community is beginning to adopt electronic health records: health information in a digital format that can be shared with providers. Unfortunately, these records may not be helpful to consumers, especially those with long-term care needs, in managing their own care. They often do not include nonmedical home care services, and the community-based agencies that provide them are far less likely to implement electronic records.

The U.S. Centers for Medicare & Medicaid Services (CMS) is trying to change these trends through a new demonstration program called TEFT (Testing Experience and Functional Tools). To learn about this innovative demo, I attended the TEFT pre-conference of the Home and Community Based Services Conference, at which CMS launched this $42 million project. Here’s my takeaway from the pre-conference and one-on-one interview with Kerry Lida, CMS project lead.

State Demos

In March 2014, CMS awarded TEFT planning grants to nine states. The states applied to participate in one or more of four demonstration components:

1) Experience of Care Survey. All nine states are field-testing a survey of consumers’ actual experience (not their satisfaction) with Medicaid home- and community-based care. The survey will be completed by a range of beneficiaries including older people, adults with physical disabilities, people with intellectual and developmental disabilities, and people with severe mental illness. The first round of testing will be completed in early 2015.

2) Continuity Assessment Record and Evaluation (CARE) Tool. Providers have used the CARE tool in post-acute settings for Medicare beneficiaries. This project will modify it for use with Medicaid clients who receive home- and community-based services. It will be field-tested in 2015.

3) Personal Health Record (PHR). State grantees will test PHRs for Medicaid clients receiving home- and community-based services. PHRs help consumers and their families manage their care by keeping useful information in one place. TEFT grantees have the option to select a PHR from a state-sponsored, commercial or Department of Defense PHR. These states must also participate in eLTSS (see below).

4) Electronic Long-Term Services and Supports Standard (eLTSS). Eight states will pilot a standard for eLTSS. They will work with CMS and the U.S. Office of National Coordinator’s Standards and Interoperability Framework to identify and harmonize electronic standards that can enable the creation, exchange and reuse of interoperable service plans for use by health care and community-based long-term care providers, payers, and the individuals they serve. The eLTSS initiative launched in November and will be open to other community, state and individual stakeholders, in addition to the eight states.

 

What’s Next?

TEFT is a four-year endeavor, but the feds, states and researchers are already sharing lessons learned. The Lewin Group is conducting an “ongoing, real time” evaluation. Truven Health Analytics is coordinating monthly training programs for the states and writing a newsletter for participating states, partners and stakeholders.The participating states recently turned in their work plans. CMS will review and then award grant funding for implementation of the plans.

“Each of the four TEFT grant components are cutting-edge initiatives,” says Lida. “We’re collaborating with multiple federal and state stakeholders to address critical gaps in quality and care assessment, which is groundbreaking.”

Michael JN Bowles