Improving long-term support & services for an MCO’s most vulnerable

A Managed Care Organization was looking to transform their Long-Term Support and Services (LTSS) function to better support the needs of their most vulnerable population. Vynamic was engaged to assess performance of the workforce, identify key opportunities for improvement, and finding ways to overcome an array of complex challenges and opportunities.

The challenge

Vynamic was engaged by a Managed Care Organization (MCO) to address process inefficiencies, workforce burnout, and challenges that the global pandemic was presenting to its traditional business model for a new and complex program. The program, Long-Term Support and Services (LTSS), went further than traditional healthcare services to address a wider range of Social Determinants of Health factors affecting vulnerable people. These supports included housing, food insecurity, transportation, and a myriad of other needs.

At the outset, the service supported over 100,000 participants, with 8 out of 10 eligible for both Medicaid and Medicare. The program involved a care team of service coordinators, case managers, and direct care workers who visited participants, assessed needs, built relationships, and acted as the catalyst to effect change and improve lives.

For this highly complex, large-scale, and truly innovative program, the MCO asked Vynamic to help them better understand how the care team was serving their participants, as well as meeting the contractual requirements of the state.

The three main challenges Vynamic was brought on to address were:

1. Process inefficiencies: The client team was overwhelmed with the wide range of population needs, and the volume of work. They were also missing the right tools and technology to handle the volume and complexity of these needs. This meant inefficiencies, duplication of effort, and a service that was not reaching its potential.
2. Workforce burnout: A labor shortage and high stress among team members was leading to low morale and high turnover.
3. Reduced face-to-face interactions: The pandemic was making face-to-face assessments and support difficult or, at times, impossible.

The approach

Vynamic’s deep cross sector knowledge across the health plan and provider industry coupled with our process improvement and change-management experience, positioned us to be the partner of choice to help the MCO improve and better serve thousands of participants.

The Vynamic team employed a three-step process, working with many stakeholders over two years:

Discovery

Vynamic took a human-centric approach, taking a deep dive into understanding the client, its capabilities, and how the service coordinators operate on a detailed level. We also analyzed the service from the participants’ perspectives to determine what they really needed and what their experience had been to date. Finally, we looked at our client’s key customer, the state, to understand its requirements and objectives.

Solution design

Vynamic coupled this deep understanding of stakeholder need and capability with several proven strategies and methodologies including population health strategies, social determinants of health strategies, whole-person health perspectives, and process and care model redesign. Using this information, Vynamic identified gaps and areas for improvement that spanned across the categories of people, process, and technology, and tested them with key clients and stakeholders to land on a final solution design.

Solution development and roll out

Based on the design, Vynamic created a detailed road map with prioritized goals to alleviate major pain points. In particular, we focused on process design to quickly close gaps in core contractual requirements, and updated the care model to reduce duplication, such as consolidating multiple participant assessments. This helped to ease pressure on the team, as well as improve the participant experience. We worked closely with care and utilization management teams to strengthen collaboration and help them develop greater empathy for each other’s challenges. From a longer-term capability perspective, we also built the business case for greater investment in tools and technology that support the overall organization as well as the frontline staff.

The result

Vynamic’s work has had a significant impact on the service, the client, its employees, and its participants, with scores of improvements made.

For the service teams, there’s now a stronger ethos and culture of collaboration, a greater understanding of each other’s roles, and a stronger feeling of empathy during this challenging time. In addition, the teams are benefiting from streamlined processes and elimination of duplication of effort. Teams have greater visibility to their work and role clarity.  This clarity promotes ownership to provide better service in addition to a clearer sense of the impact their work has. Finally, the teams feel more empowered to share ideas for improvements.

For the participants, there is less frustration, shorter referral times for services, better management and coordination across service providers, and more prioritization of those with the most urgent needs. Ultimately, there is a better participant experience.

For the client, care model redesign, process improvements, and optimization of revenue drivers has positioned the LTSS line of business to move from being a loss leader to one with significant profitability. Thanks to the improvements, the MCO has consistently enjoyed year-over-year growth as it continues to reduce servicing costs. Additionally, recommendations from Vynamic’s business case led to updates to the company’s technical architecture – the benefits of which, including more automation, are just beginning to unfold.

The client has become the top-performing division in its wider company and is now using the lessons learned, care models, and improved processes to bid for similar contracts in other states across the country. In the client satisfaction survey that Vynamic sends after each engagement, the client reported, “Vynamic’s engagement results are value added. Your team members, client service/engagement, and work product are outstanding.”