Performance Measures in MLTSS Programs: Research Brief. Outcome Measures


Outcome measures can help states and MCOs monitor member health and well-being. They can gauge whether members' needs are being met, whether they are being met in a way that addresses their personal goals, and whether the program is supporting the individual to participate as fully as they wish in their community.

Some MLTSS states also report on the effect of the MLTSS program on system outcomes. For example, Tennessee and Texas track MCOs contributions to rebalancing the states' long-term care profile by transitioning members out of nursing facilities.

Examples of outcome measures being used by states include:

  • Percent of members competitively employed.

  • Percent reduction in member falls.

  • Percent reduction in emergency room visits.

  • Percent increase in number of persons transitioned from nursing facilities to the community.

  • Percent decrease in number of members entering nursing facilities.

  • Percent increase in community tenure of persons transitioned from nursing facilities.

  • Percent decrease in hospital readmissions.

  • Percent decrease in psychiatric hospitalizations.

  • Percent decrease in episodes of law enforcement involvement.

  • Percent decrease in mental health crisis interventions.

  • Percent living in a private residence alone, with spouse or non-relative.

  • Increase in:

    • Annual dental exams,
    • Diabetes management,
    • Annual gynecological exams.
  • Number of potentially preventable hospital readmissions.

  • Number of potentially preventable complications.

Among these examples are a few that address health outcomes. This is an area that states are interested in, but about which many proceed with caution. States tend to be in agreement that measuring health outcomes in MLTSS programs is important, especially since one of the hallmarks of MLTSS is coordination of LTSS and medical care with the intent of maximizing member health outcomes. However, as many individuals in these programs are dually eligible for both Medicaid and Medicare, some Medicaid agencies are reluctant to include health outcomes until their programs are fully integrated with Medicare. While MCOs may be expected to coordinate with Medicare providers that their members use, ultimately they do not have control over Medicare providers in a Medicaid-only MLTSS program. The states argue that neither they nor their MCOs should be held accountable for outcomes over which they do not exert control. This concern should abate as increasing numbers of states participate in the CMS Demonstration to Integrate Care for Dual Eligible Individuals.

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