Across the challenges and complexities of Medicaid, few phrases roll off the tongue in this community with more negative overtones than “electronic visit verification” (EVV). To the casual listener, these three words may be jarring to the ear, conjuring up “Big Brother images,” a Governmental oversight “gotcha” mentality based on distrust – all of which is unfortunate, and truly not the intent or ultimate strategy of EVV.
Indeed, this is what makes it so ironic, as these three words describe a set of services that have the potential to bring about compassionate, high quality home- and community-based member care. EVV can be a bridge to share relevant and tailored member needs and assessments at the point of care.
Most often shortened to its less-authoritative acronym, “EVV” has evolved so much in recent years that its initial name hardly matches its value today. In its early days, EVV probably deserved some of its punitive connotation. It was almost exclusively used as a home-health program integrity tool to verify that care workers visited the members they were supposed to, stayed for only the requisite length of time before moving to the next client, and delivered the care that members were authorized to receive. Therefore, payers – first, commercial and more recently, government – intended for EVV to help target and reduce fraud, waste, and abuse.
EVV has grown up. Yes, it’s still used as a program integrity and compliance tool. But, as technology and innovation has evolved, EVV is rapidly expanding to deliver additional value to caregiver-consumer interactions in a way that can dramatically strengthen the relationship between medical/social professionals and their members, with the potential to significantly improve health outcomes.
To be sure, some of the EVV evolution has been federally influenced. The 2016 “21st Century Cures Act” mandated that states without Medicaid EVV requirements in place by January 1 of this year (for personal care services) and January 1, 2023 (for home health care services) will face reductions in their federal medical assistance percentage (FMAP). The law gives states a large degree of freedom with their EVV systems, so long as six minimum functionality requirements are met: date of service, location of service, the individual providing the service, the type of service, the individual receiving the service, and the time the service begins and ends.
To deliver the additional value, EVV today can go beyond meeting minimum requirements and provide bi-directional data to share and provide information that can be used to improve quality of care. A bi-directional EVV solution can actually serve as a “bridge” to the member to support the many benefits of remaining at home: the ability to receive care in a familiar setting, the desire or logistical requirement to be close to family members or guardians, and the feeling of independence and customization to their specific needs when their care team is actively managing your own care.
A bi-directional EVV solution can help state agencies, providers, payers, and consumers manage (and monitor) the delivery of care and services, identify health-status changes at the point of care, reduce duplications, streamline paper-based transactions, and – most important of all – better understand how home- and community-based services are improving the well-being of individuals and the population in the aggregate. For example:
- Personal care providers can submit observation reports via EVV to notify case workers of any concerns about members, such as safety issues at home, a lack of food, overall neglect, or a decline in the health of a person. If a member reports that his or her “back-up” contact – a neighbor, for instance – has moved away, the care provider can use EVV to notify the case worker to make this update and assure that the member has another back-up contact available.
- EVV reporting provides real-time care details to agencies, which allows them to be more responsive to caseload volume, and to re-assign care providers to prevent care appointments from being missed. This enables members to know that they will receive timely services to meet their needs.
Those are just a few examples to the evolving benefits a comprehensive EVV solution can provide. There are many others. Consider that because appointments and time reporting are tracked on an EVV solution, it means that the “paper time card” and submission process are eliminated – which means faster payments to care providers that are servicing members. And consider also that in states where multiple EVV vendors may be in place (in an “open” or “provider choice” state model), states can collect and generate aggregate statewide care reports for in-home services. For both state agencies and managed care organizations, this provides a coordinated view of members, the services they receive, the cost of delivering those services. When this coordinated view is cross-referenced with other health information, the member becomes the recipient of higher, more efficient delivery of care and services.
Ultimately, EVV can facilitate a better way to provide access to care for a population that needs these services, and even more important, for individuals who much prefer or need to receive those services in their own homes. The Cures Act projects a 26 percent growth in personal care services between 2014-2024, due to demographic changes and the increasing desire among an aging population to receive care outside of an institutionalized setting.
All of these add up to something much more important and vital, something that’s hard to define but evident when you see it – the quiet satisfaction that accompanies a sense of dignity.
It’s hard to imagine a more critical mission for EVV. The days of the punitive overtones should be dispelled. As the tools and use of EVV evolve, EVV has the potential to provide all the benefits encapsulated in another popular three-letter acronym.
About the Author:
Senior Vice Director at Optum
Suzanne Crane is a Six Sigma Green Belt with over 20 years of program management and implementation experience, including 15 years in technology health care SDLC. She has 13 years of Medicaid experience and 18 years in process improvement and business process development. Suzanne leads the Optum Electronic Visit Verification (EVV) product priorities and drives product features that service the LTSS population and providers. Suzanne collaborates with states to establish consistent governance and management processes for successful solution delivery. She holds a Master of Business Administration degree.