Managed Long Term Care

ILS Managed Long Term Care is a suite of support service solutions designed to promote and facilitate member-centric integrated care while maximizing community living for both aged and disabled individuals and others with special needs. Our clients and partners include:

• Health Plans
• Managed Care Organizations (MCO’s)
• Accountable Care Organizations (ACO’s)
• Integrated Care Organizations (ICO’s) serving dual eligibles
• Patient Centered Medical Homes (PCMH’s)

ILS offers “high-touch”, “low-cost” service solutions that promote independent functioning at the highest level possible. Our services, combined with ILS’ innovative systems that monitor, measure, and report on care delivery performance. They help promote improved health status and provide a positive care experience for members.

With a focus on promoting and enabling independent living, ILS Managed Long Term Care (MLTC) provides a comprehensive set of unique care delivery supports for dual eligible beneficiaries, elders, disabled and other individuals with complex care needs. We focus on engaging members and providing customized long term services and supports in their homes or in a community setting. We assess what resources are available to them in the community, provide referrals as needed, and assist them with applications to receive those services. ILS MLTC enables dual eligibles, elders, and disabled individuals to be successful in living in the least restrictive, most appropriate cost effective setting.

Fundamental to our care approach is working with our health care partners to keep members in their homes and out of nursing facilities, emergency rooms, and hospitals through early identification of health issues. We work with our health plan partners to identify gaps in service delivery that are a threat to a member’s ability to live in the community and design targeted interventions. ILS understands that properly aligning quality measurement and reporting is essential to an efficient monitoring system, and will contribute to improved enrollee outcomes and satisfaction.

ILS provides integrated technology services designed to address the unified care delivery life cycle from member enrollment to care management through provider payment and financial reporting to our partners.

Key components of ILS Managed Long Term Care’s innovative platform of services and technologies include:

Network Development: A comprehensive network of diverse providers is essential for all MLTC programs. Our network includes a variety of health care, social and support service providers. ILS will identify and contract with community providers for long-term services and supports (LTSS) aimed at enabling the member to live as independently as possible. ILS credentials its networks of providers in accordance with all regulatory requirements.

Assessment: The MLTC program’s unique assessment model is focused on providing a holistic evaluation of individual member’s needs for long term services and supports to enable them to live as independently as possible in the community. Assessments focus on assisting with daily living activities including finances, meals and nutritional support, living arrangements, home modifications and safety, transportation and access to care or special accommodations that may be needed. Home visits, in addition to telephonic contact, are essential in order to get a true sense of how a member lives and what their needs are while promoting consumer engagement in care planning.

Individual Care Planning: Our team designs individual care plans for elders, disabled and dual eligible members incorporating long term services and support provided by ILS. Medical, behavioral and pharmaceutical services are provided through the member’s health plan or integrated care organization. These care plans are focused on providing the right blend of cost effective services to maximize health outcomes and satisfaction of members while enabling them to remain at home or in the community.

Comprehensive Care Management: ILS offers member-centric high-touch services with 24/7 clinical availability for individuals with multiple chronic conditions and/or serious medical needs. We offer an unparalleled value in managing high cost members through a specialized services and technology platform. ILS leverages its robust, proprietary cloud-based systems of health care data analytics, tracking, monitoring and reporting systems to support its Comprehensive Care Management efforts.

Referral and Authorization System: To ensure that needed services are properly authorized, referrals are made in a timely manner and services are delivered. ILS employs a fully integrated automated process for both the front-end authorization and referral system and the back-end monitoring and reporting system. Our R&A system is tied to our claims processing systems streamlining the process for billing and utilization management.

Claims Processing: Traditional health care providers submit claims via HIPAA compliant electronic transactions or on CMS 1500 forms. Community providers of social services and LTSS bill differently using various formats and reimbursement models. ILS’ system can easily handle claims in almost any format and its system will process claims in a timely and accurate manner with appropriate accounting and tracking systems.

Reporting: ILS provides health plans and integrated care organizations serving dual eligibles reporting capabilities designed to meet requirements on enrollment and financial performance identified by our health organization partners and CMS.

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