Anticipating the spread of managed care in the sector, the American Health Care Association (AHCA) has issued a series of principles for providers to consider when they work on managed care contracts.

Key to success are managed long term services and supports (MLTSS), AHCA says. Advocates urge providers to focus on the following:

■ Improve access and quality first.
Savings in long term care should come from “care coordination, prevention and wellness, and quality initiatives,” AHCA says. “Rate reductions, unnecessary utilization controls, or cumbersome prior authorization processes are not the answer for individuals who need these sorts of supports.”

■ Demonstrated experience with services and supports.
With only about 4 percent of people using long term care enrolled in managed care, the managed care marketplace has “limited exposure to and experience in coordinating delivery of LTSS,” AHCA says. There should be a “federal readiness review” and federal benchmarks for MLTSS programs.

■ Meaningful opportunities to make educated decisions.
Residents should have the ability to make decisions about enrollment and have an adequate choice of providers, services, and settings.

■ Independent grievances and appeals processes for individuals and providers.

■ Access to care when people need it—even if it means sending residents outside of managed care networks.

■ Administrative efficiency and consistency across plans.

■ Care coordination that produces efficiencies while improving health experiences.

■ Consideration of all views and perspectives when creating MLTSS programs.

Lynn Wagner