Which EVV Model is Right for Your State?

Last week, in the first installment of our series on mandated Electronic Visit Verification, we reported on our conversation with Sandata CEO Tom Underwood about the ways states might choose to comply with the 21st Century CURES Act. (See “Four EVV Models States Might Choose; Three Lead to Disaster” HCTR, August 16) In part two, we reprint, with his permission, charts that detail his recommended strategy for each stakeholder category: providers, states, and MCOs.

Decision Criteria for States
Underwood emphasizes that each state must carefully evaluate its unique environment in order to select the EVV model that is right for its program. Factors to consider include concerns impacting fraud, waste and abuse, impacts to the provider network, overall service quality, and how states are using Managed Care companies to deliver services. He explained that his company has summarized each of the models based on how favorable they are to the state using the following measures:

  • Compliance:  Measured in terms of rate of adoption of the mandated EVV technology;
  • Cost:  Cost to the state to implement (assumes enhanced federal match of 90%);
  • Business Burden:  How much time and effort the state must expend to implement and manage the program;
  • Ease of Implementation:  How easy or challenging is the program to implement on a statewide basis;
  • Outcomes:  How much savings will the state expect to recoup based on impacts to fraud, waste and abuse.

    Chart #1 shows the Sandata scoring of these measures on a five-point scale for each of the EVV models described in last week’s installment, where one indicates the fewest advantages to the state and five the most:

    On all five measures, two of the models offer mixed benefits to states, the Open Vendor model scores a perfect row of fives, and the model that allows MCOs to select the EVV vendor of their choice is disastrous for all.

    Decision Criteria for Providers
    To the extent that a state’s providers can influence the path their state takes, it is essential that providers and their state association representatives know what direction their advocacy should take. Before lobbying, therefore, each provider must carefully evaluate the available models and know how each will directly impact their business. Underwood reported on a summary Sandata prepared showing how favorable each model is to providers, factoring in the needs of and burdens on providers operating in multiple states, using the following measures:

    • Compliance:  Measured in terms of rate of adoption of the mandated EVV technology;
    • Cost:  Cost to the provider to implement;
    • Business Burden:  How much time and effort the provider must invest to be compliant;
    • Ease of Implementation:  How easy or challenging is the program to implement;
    • Outcomes:  How much savings will the state expect to recoup based on impacts to fraud, waste and abuse.

    Chart #2 shows the Sandata scoring of these measures on a five-point scale for each of the EVV models described in last week’s installment, where one indicates the fewest advantages to the state and five the most:

    According to these scores, allowing MCOs to select different vendors is as harmful to providers as it was shown to be to states in the previous chart. The preferred model, Open Vendor, is not perfect from the provider’s perspective. This model shares some costs between the state and the provider and it does not score quite as high on the “ease of implementation” scale as the Provider Choice model does. Nevertheless, overall, it is the model that best supports provider compliance and outcomes while imposing the least burden on the provider’s business.

    Decision Criteria for MCOs
    In his presentations to state association audiences, Underwood includes a message for Managed Care Organizations. “Each MCO must carefully work with the state to support EVV in a managed care model,” he explains. “Factors to consider include concerns impacting fraud, waste and abuse as well as impacts to the provider network.” His summary of each of the models is based on how favorable they are to MCOs, using the following measures:

    • Compliance:  Measured in terms of rate of adoption of the mandated EVV technology;
    • Cost:  Cost to the MCO to implement;
    • Business Burden:  How much time and effort the MCO must expend to implement and manage the program;
    • Ease of Implementation:  How easy or challenging is the program to implement on a statewide basis;
    • Outcomes:  How much savings will the MCO expect to recoup based on impacts to fraud, waste and abuse.

    Chart #3 shows the Sandata scoring of these measures on a five-point scale for each of the EVV models described in last week’s installment, where one indicates the fewest advantages to the state and five the most:

     

    This is the only stakeholder group that gains even a minor benefit from the MCO Choice model, though not enough to justify implementing it. Conversely, the State Choice model is stronger than the Open Vendor model with regard to compliance support. Nevertheless, the State Choice model’s extreme business burden and implementation difficulty put it second to the overall preferred model, Open Vendor, provided measures are put in place to bolster compliance in other ways.

    Watch Results From First Open Vendor State
    To date, Underwood’s declaration that the Open Vendor model will be more successful than the others for all stakeholders is largely based on theoretical analysis, but not for long. Florida’s Agency for Health Care Administration has accepted the challenge to implement this new model after scrapping its failing first attempt, State Choice. Ohio is also preparing a modified version of Open Vendor but is still in the planning stages.

    Details: In Florida, the state will bear the costs if providers select a bare bones solution from Centric Consulting. Providers needing full EVV functionality and efficiency, not available from the Centric Consulting system, may contract with — and pay for — any vendor of their choosing that meets certain state standards, such as data exchange compatibility with the AHCA system.

Read the full article here (Tim Rowan- Rowan Technology Report)