Where systems “collide” is often where we have problems serving consumers in the health and human service field. Good examples are the corrections system and the mental health system; the educational system and the disability support system; and, I think, the foster care system and Medicaid managed care programs.
But it is necessary for service provider organizations serving children in the foster care system to bridge this gap because the Medicaid managed care programs are here to stay – and states are more often including foster care children in Medicaid managed care coverage. For example, we just reported last week that, after federal approval, New York State plans to move Medicaid services for children in foster care from fee-for-service (FFS) to managed care, starting in April 2013 (see New York State Moving Children In Foster Care From FFS Medicaid To Managed Care).
The question for organizations serving foster children is how best help them access health care services as their coverage shifts to a managed care model. I think there are a few key considerations.
Prepare for the mechanics of managed Medicaid care – Children in foster care are “high utilizers” of health care services – so they need provider organizations that know how to access services on their behalf. Your organization needs to understand how to advocate for services in a managed care system. And, if you provide those services, to have contracts with managed care organizations – along with the infrastructure for financial sustainability. This infrastructure includes contracting and referral development, utilization management, enhanced clinical documentation requirements, billing and collections, collection of consumer payments, and enhanced information systems capabilities. Good resources on this topic include A Checklist for Managed Care Readiness for FFS Contracting , CHCF Releases Managed Care Assessment Tool to Review Plan Readiness to Serve Beneficiaries With Disabilities , Best Practices In Rural Medicaid Managed Behavioral Health , and Beyond FFS all members.
Plan for Coordinated & Integrated Systems – Medicaid managed care plans (and Medicaid fee-for-service plans, too) have a growing preference for coordinated and integrated service delivery systems. Hence all the health homes, medical homes, ACOs, and specialty care management programs. Your organization needs to figure out how to “plug in.” Good resources on this topic include: Thinking About Integration? You’re Not Alone all members and Thinking About Integration? Seven Measures To Create A Sustainable System all members.
Prepare For Accountability & Outcomes – With managed care organizations as payers, there is a pronounced shift to accountability for performance: performance measured as consumer access, consumer satisfaction, consumer outcomes, and “market” rates. To improve their strategic positioning, provider organizations need to optimize their performance in these areas with effective treatment planning, unit cost management, and better aftercare planning. Good resources on this topic include: P4P Meets Title IV-E all members, Making Pay-For-Performance Work all members, and The Decision Supports Tools Needed To Succeed In Pay-For-Performance Arrangements.
If your work with a provider organization and your state has not already moved the health services for foster children to some form of managed care, I think it is a matter of “when” rather than “if.” And, even if the foster care issue isn’t one that concerns you, working with Medicaid managed care plans is an increasingly universal market situation.
For another free resource, see: Treating The Whole Child all members