The Role of Electronic Visit Verification in Enhancing Quality, Efficiency, and Medicaid Integrity

Please introduce yourself by stating your name, title, organization, and professional background.

My name is Stephen Vaccaro, and I serve as president at HHAeXchange, the leading provider of homecare management solutions for providers, managed care organizations (MCOs), and state Medicaid agencies. In my role, I lead HHAeXchange’s market strategy and the national expansion of our providers and portfolios. I have over 25 years of leadership experience in the health care industry, having spent time on both the payer and provider sides of the market. I also have a background in sales, service delivery, strategic planning, project management, profit and loss management, product development, and acquisition integration.

Can you discuss the critical role that Electronic Visit Verification (EVV) services play in ensuring accurate and timely documentation of homecare visits? How does this technology contribute to improved patient outcomes and the overall quality of care provided?

EVV facilitates uninterrupted service delivery monitoring in real-time, and over time. By capturing visit data, EVV empowers agencies with comprehensive insights and analysis capabilities to evaluate care quality and health outcomes throughout the member experience. This is useful to all stakeholders involved in the continuum of care–from broader health care teams and practitioners to payers and health plans. EVV offers a seamless experience for recording all homecare visit details, eliminating the need for manual or paper timesheets. This streamlined process significantly reduces the risk of fraud, waste, and abuse (FWA) as electronic systems are inherently more secure than paper-based methods. Tracking time and attendance serves as a fundamental measure of quality. It ensures that the right member receives the right care in the right setting at the right time.

Furthermore, the EVV framework enables enhanced compliance tracking for care plans. Health care providers can proactively address issues reported by homecare workers through the platform, mitigating potential adverse effects on patient conditions and preventing future medical emergencies.

From the perspective of Medicaid, why is there a vested interest in enforcing and ensuring compliance with EVV requirements? How does accurate EVV contribute to more effective utilization of health care resources and reduced health care costs?

EVV serves as a robust system that electronically verifies caregiver visits to members' homes and within the community and documents the services rendered. Recognizing its pivotal role in combating FWA, Medicaid payers are deeply invested in enforcing EVV compliance due to its profound impact on overall costs and member outcomes. To streamline processes, Medicaid Management Information Systems (MMIS) can be seamlessly integrated with EVV systems, enabling automated cross-checks of billed claims against submitted visit data to identify any discrepancies. Consequently, instances of billing errors and improper Medicaid payments are significantly reduced, safeguarding agencies against fraudulent claim allegations.

EVV platforms offer additional resources that enhance timeliness, record accuracy, and online security, such as automated billing, scheduling, and other administrative work. Those cost- and time-saving features allow agencies to empower their most valuable resource – their caregivers. EVV's effectiveness spawns efficiency, optimizing workflows so caregivers can take time to note important changes, report updates, and voice any concerns they may have about a member's health. Embracing that approach to simplify and streamline duties is crucial in light of the industry's challenges with caregiver shortages and increasing member needs, making staff retention a top priority. By easing caregivers' workloads and paring down operations, EVV can alleviate caregiver turnover rates.

In addition, any issues flagged will trigger immediate action, resulting in an intervention that could prevent a problem from spiraling into a major medical emergency down the road. This saves everyone–including members and their families, payers, and providers – money and time. Ultimately, EVV contributes to improved outcomes across the board.

In what ways does EVV help address fraud and abuse within homecare services, and how does this directly impact the integrity of Medicaid programs and payer budgets? Can you share specific examples or case studies illustrating the effectiveness of EVV in this regard?

EVV offers robust reporting capabilities that enable comprehensive comparison and measurement of homecare visits and claims/encounter data for compliance. This aligns with the reporting requirements and audit criteria set by oversight bodies, such as health plans or State Medicaid agencies, aiming to effectively combat FWA while ensuring program integrity. Advanced software solutions encompass pre-bill or pre-claim generation edits, which verify the presence and accuracy of EVV data before a claim is even generated. This proactive approach significantly reduces the likelihood of claim rejection or erroneous payment by payers, minimizing the possibility of recoupment down the road. By establishing evidence of EVV's presence during the provision of homecare services, Medicaid can confidently process claims, alleviating concerns regarding potential manipulation of visit data. Additionally, EVV software should empower providers to conduct routine internal quality assurance audits and implement approval rules that restrict certain tasks, such as visit edit approvals and timesheet uploads, to designated users like managers.

The New York-based agency, Caring Professionals, is a great example of EVV benefiting the budgets of both a provider and payers. Caring Professionals facilitates approximately 3,000 visits each day. Without EVV, the company’s leadership estimates they’d need one coordinator for every 50 homecare workers in order to maintain compliance, ensuring each visit takes place at the right time and location, all care plan tasks are carried out, and all the relevant information is properly documented and included on claims to Medicaid. Instead, EVV has allowed the agency to utilize one coordinator for every 150 workers–a 66% decrease in administrative need that enabled team members to spend their time administering quality care to patients instead of tackling paperwork. The time and money Caring Professionals saves through simplified scheduling, expedited billing, and automatic and accurate claims generation means providers and health plans come out ahead, as claim denials, rejections, and delayed payments are reduced.

As technology evolves, how can Medicaid and payers adapt their policies and strategies to maximize the benefits of EVV? What are some challenges and opportunities in staying ahead of the curve to ensure that EVV continues to positively influence patient outcomes and health care costs?

Medicaid agencies and payers play a crucial role in supporting the adoption of emerging technology-enabled solutions to advance the industry's overarching goals of enhancing access to care, delivering higher quality services, and promoting health equity for better member outcomes. States have the opportunity to take proactive measures in exploring and implementing strategies that encourage and streamline the adoption of technology-enabled solutions. The demand for homecare is rising dramatically. So, the real benefit of staying ahead of the technology curve comes down to being able to meet that demand while still providing excellent care and retaining the amazing caregivers who serve as the backbone of the entire industry–and other home- and community-based service (HCBS) segments can follow suit.

The real-time access to caregivers in the home marks a significant milestone in HCBS history. Providers and states are increasingly recognizing the immense value of EVV, and many are seeking ways to further capitalize on its potential. The future holds promising possibilities for wider implementation of EVV among various service providers and populations where home visits are prevalent. The technology holds the potential to further enhance data accessibility for stakeholders, enabling them to harness valuable insights more effectively if EVV usage expands among other providers, such as doulas and midwives who care for expectant and new mothers or those who offer hospital-at-home services. EVV is poised to become an integral component of the broader home-based health care landscape, extending far beyond traditional homecare teams.

What is one thing you’d like the audience to walk away with from this interview?

The advancement of EVV and the technology it’s built on present an opportunity to integrate visit data with other population health datasets, potentially revolutionizing best practice service delivery and further improving member outcomes. EVV enables the comprehensive capture of the entire member experience, including data on social determinants of health and other influential factors. By leveraging this technology, caregivers can gather even more critical data beyond the six elements required for EVV compliance. It is important to recognize that EVV is a permanent fixture in the industry. Rather than viewing it as a task or another requirement, we should acknowledge the significant positive impact it has had so far and anticipate further advancements in the future.