State Medicaid agencies have been hit hard during the COVID-19 crisis. Over the last several weeks, there has been an unprecedented increase in member enrollments, as well as significant disruptions in care delivery due to stay-at-home orders. As states shift their focus to implementing new policies to ensure continuity of services and mitigate the risk of COVID-19 within high risk populations, these efforts reinforce the everyday best practices for managing and monitoring critical incidents. With a comprehensive incident management system and critical incident reporting process in place, states can more effectively identify at-risk populations, deliver necessary interventions, and monitor the adequacy of current and ongoing care to prevent incidents in the future. These measures are always vital—even more so during a global pandemic such as this one.
Use of Critical Incident Management
Critical incident management refers to the polices and processes, analytic tools, and technology system a state implements to accurately and promptly report, investigate, and remediate events that cause harm to members in order to promote better health and safety outcomes.
A critical incident reporting system with the capacity to accurately collect reported events and complete trend analysis better enables state officials to:
- Identify members most at risk in crisis hotspot areas who could benefit from proactive planning
- Perform data analytics to identify geographical regions with more concentrated pockets of diminished provider services
- Communicate with provider networks and case management agencies to perform more efficient prevention planning and follow-up
- Determine if additional provider resources are available and could be deployed to reduce the rate of incident occurrences
- Monitor providers whose current patient care levels indicate a high rate of critical incidents
- Implement reporting systems that can rapidly and easily source data to provide insights and ensure effective monitoring of the adequacy of care.
Critical incident management best practices assist states not only during normal day-to-day operations, but in times of crisis.
Responding to Critical Incidents During, and After, A Crisis
When a health crisis occurs, such as COVID-19, states will naturally see an increase in incidents, which could lead to unplanned hospitalizations requiring major care reviews. Several other indirect factors drive an increase in incidents during times of crisis. These could include: incomplete care plans, medication mismanagement, or the identification of staff inadequately trained to provide care based on the client’s needs. Additionally, many daily touchpoints for clients—such as adult day center attendance, corollary health services like vision or dental services, and supported employment—are currently closed or managed via telehealth, thereby eliminating standard avenues to identify critical incidents. Finally, providers servicing home and community-based services (HCBS) members may be experiencing a reduction in staff availability, resulting in rescheduled visits or altogether cancelled services. These factors combined mean that crises have the potential to exacerbate the occurrence of incidents, interrupt care delivery, and/or remove the state’s ability to perform proper prevention planning.
However, many of these incidents—which might normally go unreported—are most often discovered when there’s a heightened concern for the care and well-being of members. At a time when care is essential, resources are stretched, and communication is sometimes haphazard, states must be able to rely on clear incident management processes and systems to ensure the continued health of citizens. With a robust critical incident reporting system in place, states can utilize data analytics to quickly and appropriately detect, report, investigate and remedy crisis- or pandemic-related incidents on a comprehensive and holistic level.
PCG can assist your state Medicaid agency with COVID-19-related waiver and legislation implementation, IT updates, claiming guidance, and more. Click the thumbnail on the left to read an overview of our COVID-19 response services.