Step 4: Select a Model

After reviewing available LTSS models, you should closely study the LTSS models to understand how each relates to your community.

Community-Related Considerations

Carefully consider the impact, required resources, sustainability and cost-effectiveness of each model before you select one.


Will the model address the LTSS needs you identified for your community?

Required Resources (Non-Financial)

Does your tribe have enough people and technical skills to support the model? Becoming familiar with state regulations and related best practices can help you decide what non-financial resources are necessary to implement an LTSS model.

Examples of non-financial resources:

  • Experts in the areas your program needs
  • Broadband Internet access
  • Electronic health records
  • Cell phones
  • Diagnostic and treatment equipment

What types of things are needed to implement the model?

  • Licensure
  • Insurance
  • Building (construction, rent, operational costs, maintenance, etc.)
  • Equipment
  • Personnel (required staffing ratios, training, etc.)
  • Staff housing
  • Transportation for staff or clients

What are your state's policies on LTSS services and reimbursement? See the State Resources Map to learn more about your state's requirements.

  • Quality of care standards
  • Reimbursement
    • Which services can be reimbursed under the state Medicaid plan?
    • Which services can be reimbursed under your state Medicaid waivers?
    • How are services authorized under the state Medicaid plan?
    • What are the requirements to contract for services?
    • What is the billing process for the model chosen?

Sustainability and Cost-Effectiveness

Based on the data gathered in your needs assessment, will you serve enough people to make your chosen LTSS model work? A good way to see how many patients you need to serve to avoid losing money is to do a break-even analysis.

Another question to think about is: how do the cost and level of care for a certain model compare to other models?

The information on this page, as well as in the TA Center Financing section, can help guide you through the process of setting up your finances.

After considering these factors, a SWOT analysis can assist your final choice of the right model.

SWOT Analysis

SWOT stands for Strengths, Weaknesses, Opportunities, and Threats.

Strengths and weaknesses are internal factors that you and your tribe can control.

Opportunities and threats are factors outside of your control that exist at the national, state, or community level and may affect your LTSS program.


  • Strength: a physician in your tribal program is a trained geriatrician (internal)
  • Weakness: some medical staff are not qualified to bill Medicaid (internal)
  • Opportunity: a nearby tribal college is planning on creating an HCBS program (external)
  • Threat: the state government is considering cutting Medicaid funding for LTSS (external)

A SWOT analysis will help you identify internal and external factors that may influence the way you implement your LTSS program, and allow you to plan accordingly. This analysis can be useful at many points throughout the LTSS planning and implementation process.

You can organize factors into a SWOT matrix to help you visualize your situation.

Sample SWOT Matrix

4 Steps of a SWOT Analysis

Complete these steps to do a SWOT analysis:

  1. Hold a meeting of people who know about LTSS, health care, elder care, social services, and Medicare and Medicaid services and programs.
  2. Create a list of strengths, weaknesses, opportunities, and threats for your LTSS project.
  3. Review and discuss the items in each of the four categories, ensuring items are in the correct categories.
  4. Develop action items that deal with each quadrant of the SWOT matrix. Examples of action items include:
    • Strengths: How can we take advantage of each strength to expand or build LTSS?
    • Weaknesses: How can we address and correct these weaknesses?
    • Opportunities: How can we use these opportunities to benefit our program?
    • Threats: How can we reduce the risks posed by these threats?

The SWOT analysis steps above will provide information that can help you decide whether a particular LTSS model will be a good fit for your community and its needs. When your analysis is complete, you can choose the LTSS model that best fits your community. Now you are ready to begin a collaborative planning process to decide how to implement the model you chose. Proceed to Step 5.

Page Last Modified:
06/22/2016 10:53 AM