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Medicaid Concepts: Electronic Visit Verification

This is part of our Medicaid Concepts series, in which we provide a high level overview of key concepts in the Medicaid industry today.

What do we mean by electronic visit verification (EVV)?


Electronic visit verification (EVV) is a category of technologies and services used to validate that a visit actually occurred (usually in the member’s home). While EVV has been around for a long time, the 21st Century Cures Act made it mandatory for all state Medicaid programs by January 2020 for personal care services and January 2023 for home health services.

At a minimum, EVV systems must document:

  • Date of service
  • Location of service
  • Individual providing service
  • Type of service
  • Individual receiving service
  • Time the service begins and ends

What role does Medicaid play?


In addition to implementing required EVV systems, Medicaid agencies are in a unique position to leverage EVV data to improve member service provision. Medicaid agencies also play an important role in educating members on the benefits of EVV and reassuring those members that have privacy concerns related to GPS data tied to their home.

While EVV is primarily designed to prevent fraud in the Medicaid system, there are opportunities to use EVV data to improve care coordination and identify member quality gaps. The ability to use EVV to improve member outcomes is only beginning to be explored.

Explore further
https://www.medicaid.gov/federal-policy-guidance/downloads/cib080819-2.pdfhttps://www.medicaid.gov/sites/default/files/2019-12/evv-requirements-intensive.pdf

https://www.medicaid.gov/medicaid/data-systems/outcomes-based-certification/electronic-visit-verification-certification/index.html

https://medicaid.publicrep.org/feature/electronic-visit-verification-evv/

https://medicaid.ohio.gov/INITIATIVES/Electronic-Visit-Verification

https://medicaid.georgia.gov/programs/all-programs/georgia-electronic-visit-verification-evv

https://chfs.ky.gov/agencies/dms/dca/Pages/evv.aspx

https://dhhs.ne.gov/Documents/EVV%20October%20Slides.pdf

https://www.in.gov/medicaid/providers/1005.htm

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Medicaid Concepts: Member Engagement

This is part of our Medicaid Concepts series, in which we provide a high level overview of key concepts in the Medicaid industry today.

What do we mean by member engagement?

With so much focus in the Medicaid space on improving health outcomes for the sickest, most vulnerable populations, the need to have the member engaged in their own health is clear. “Member engagement” is a broad term that includes a range of ideas: treatment compliance, emergency room avoidance, self-directed care, decision-making, health assessments, and member onboarding.

All efforts centered on member engagement are based on the idea that people will make better healthcare decisions when they are more engaged. One of the biggest obstacles to increasing member engagement today is the overload of information. It is increasingly difficult to get the member’s attention in an information-rich world of social media, email and entertainment.

Member engagement should not be confused with care management. Care management describes a model focused on care coordination, treatment pathways and targeting members with complex needs. While care management also relies on member engagement, the two terms are not synonymous.

What role does Medicaid play?

Over the past several decades, Medicaid agencies have worked to improve member-engagement. Many of the earlier efforts evolved out of the disease management programs of the late 1980s and 1990s. Newer efforts focus on maximizing the effectiveness of communications to members, targeting specific members to close quality gaps and aligning incentive programs to encourage healthy behaviors.

While much of the member engagement effort focuses on newer technology solutions (think smartphones or telehealth), there are still important functions related member engagement that happen in a call center, or when a member fills out a member satisfaction survey. Medicaid agencies, health plans, and providers all have opportunities to increase member engagement in a wide range of settings and thereby improve health outcomes.

Explore further

https://carenethealthcare.com/medicaid-member-engagement-strategies/

https://medcitynews.com/2018/09/here-are-some-high-impact-engagement-strategies-for-medicaid/?rf=1

https://www.chcs.org/media/PRIDE-Culture-of-Engagement-FINAL.pdf

https://healthpayerintelligence.com/news/how-to-improve-medicaid-member-engagement-care-coordination

https://www.colorado.gov/pacific/hcpf/performance-measurement-and-member-engagement