Medicaid long-term care workforce training intervention and value-based payment metrics

Area of Science:

• Healthcare Management
• Public Health Policy
• Gerontology

Background:

• Value-based payment models incentivize quality care in managed long-term care.
• Workforce training is a key strategy to improve direct care worker performance.
• Understanding the impact of scaled training interventions is crucial for optimizing care delivery.

Purpose of the Study:

• To evaluate the effect of a large-scale workforce training program on value-based payment measures.
• To assess the association between trained home health aides and client outcomes in a Medicaid population.
• To identify differential impacts of training based on client needs.

Main Methods:

• Quasi-experimental design using merged health assessment, claims, and training data (2018-2020).
• Defined exposure based on service hours from trained aides.
• Multivariate logistic generalized linear and additive models analyzed associations with value-based measures.

Main Results:

• Significant associations found for 4 of 7 value-based measures, with effects varying by client need.
• Positive impacts observed for flu vaccination (average-need), pain control (above-average and heavy-need), and shortness of breath (light-need).
• Over 27% of clients received services from trained aides.

Conclusions:

• Scaled workforce training demonstrated mixed but potentially beneficial effects on value-based metrics, particularly for high-need clients.
• Training benefits are client-specific, highlighting the need for tailored approaches.
• Value-based models should incorporate health indicators sensitive to direct care worker support.