All Medicaid managed care programs must have an ongoing series of PIPs focused on clinical and non-clinical areas.20 In this inquiry, our interest was to discover the types of PIPs MLTSS programs conduct and if they have particular relevance to MLTSS services and/or populations--in essence whether the programs require their MCOs to engage in LTSS-specific PIPs.
PIPs often span more than one year as they require time for design and implementation, as well as time to review results and draw conclusions about the PIP's impact. Two of the study programs require the MCOs to conduct at least one LTSS PIP (Pennsylvania, Wisconsin); two states mandate two LTSS PIPs (Michigan, Tennessee); and two programs require three LTSS PIPs (North Carolina, Texas). In some states, some PIPs are dictated by the state, where in others they are at the discretion of the MCO. In some cases, the state may periodically mandate a specific PIP (e.g., in 2012 Tennessee required a PIP on rebalancing). In Texas, the EQRO establishes two of the three PIPs with the third at the MCO's discretion. Examples of LTSS PIPs in addition to Tennessee's rebalancing PIP include improvement initiatives on:
- Increased use of adult day care;
- Increased integration of behavior and physical health;
- Increases in depression screenings;
- Reduction in preventable hospitalizations;
- Increases in diabetic care; and
- Reduction in nursing facility rates.
Another approach that surfaced is an initiative in Texas and Minnesota where MCOs work together to develop collaborative PIPs. The advantages of this approach is that the MCOs are not working at odds with each other, and it is especially helpful for providers who may be involved in implementing PIPs who work for more than one MCO.