Requiring standardized assessments to gauge progress and member/family needs are one of the few measurable ways health plans ensure medical necessity is being met.
Such outcome measures range from member focused, such as annual adaptive behavior evaluation requirements (i.e., Vineland, Adaptive Behavior Assessment Scale, Behavior Assessment System for Children) to caregiver centered where areas of stress and potential need for resources (i.e., Parent Stress Index, Stress Index for Parents of Adolescents) are determined to evaluations for Autism symptom severity (i.e., Social Responsiveness Scale).
The Pros:
Use of standardized assessments for adaptive skills and ASD symptoms helps quantify present level of functioning and identify gaps between developmental and chronological skill sets. As such, these measures can be used as indicators to predict treatment outcomes.
These indicators of treatment response indicate quality of service and aid in finding the balance between service quality and efficiency. These evaluations also measure quality of life outcomes and aid providers in treatment planning to ensure the most relevant, clinically significant areas are targeted in treatment.
Completion of caregiver stress indexes advance case management in a more holistic way. By identifying areas of need, specifically targeting Social Determinants of Health (SDOH): caregiver strain, financial stress, housing concerns, relationships, emotional supports etc., applicable resources can be identified and provided to families.
As caregiver stress decreases, implementation of behavior plans, generalization and maintenance of skills targeted in parent training by the Behavior Analyst increases, ultimately improving outcomes for the member with Autism as well.
The Cons:
Money, time, and effort are a commodity when raising children, especially those with Autism. Areas of difficulty to caregivers regarding completion of requested assessments include:
- Limited supply of specialists who complete evaluations
- Wait lists for specialist appointments
- Managing high number of specialist appointments
- Cost (co-pay, deductible, gas/transportation)
- Travel (especially for those in rural areas)
- Check-in lines, waiting room and other overstimulation which is challenging for members with ASD
- Loss of work during appointment times
- Childcare for other children
The Solution:
Investing in the ability for caregivers to complete medically necessary outcome measures remotely, when their time allows, without additional cost, travel, or stress directly benefits both the health plan and family.
By easing the burdens associated with testing, health plans ensure they receive the evaluation results in a timely manner, then they need them, to make care determinations and provide a seamless referral plan for resources and supports.
Reports regarding parent stress and SDOH are of utmost importance to the child and family’s well-being and should not be left for optional completion. High level of caregiver distress, dysfunctional parent-child interactions, and rating of difficulty of the child have the potential to place the child at risk for neglect and/or maltreatment which need to be identified and addressed as crises. These evaluations flag for potential physical and sexual abuse, medical trauma, and domestic violence.
Also, of direct impact and of critical importance to the family unit are SDOH related to lack of resources to meet daily living needs, discrimination, unmet health needs, limited language access, economic instability etc. It is crucial that caregivers have the ability to complete these assessments in order for case management to successfully identify and support these needed populations without delay.
The process of utilizing online evaluations with applicable scoring protocols in place ensure the reports maintain reliability and validity, are completed in a timely manner, enable continuation of benefits, and provide essential insight for case management.
For more information on the Outcome Measures process, contact us.
