If you are an executive of a provider organization serving consumers with intellectual and developmental disabilities (I/DD), there is a good chance you’ve heard the phrase, “Technology First.” But if you aren’t working in one of a handful of states that have adopted a technology-centric approach—including Alaska, Delaware, Indiana, Missouri, New York, Ohio, Pennsylvania, Tennessee, and Wisconsin—then you might not be familiar with the details.
Generally speaking, “Technology First” initiatives are plans to expand access to technology for people with developmental disabilities—with the goal of promoting their ability to live as independently as possible in the community (see Ohio Technology First Council, Session One: The Current Status & Future Possibilities For Technology). In committing to “Technology First”, a state makes a public commitment to integrating technologies into their reimbursable services. “Technology First” goes hand-in-hand with a consumer-directed care approach and helps consumers to decide what structures and supports will work best for them. What are the technologies that are the focus of the Technology First initiatives? The initiatives commonly refer to assistive in home technologies, remote monitoring, mobile tracking applications, and other similar tech innovations.
The adoption of the “Technology First” approach has been slow but steady. Most recently, in February, the Missouri Department of Mental Health (DMH) announced that Missouri is becoming a Technology First state and will focus on evaluating and implementing technology-related solutions that improve the quality of life for individuals. Missouri DMH intends that “Technology First” designation will support self-directed services. According to Missouri DMH, the goal is to serve more than 1,600 people by the end of 2021. (For our complete story, check out Missouri Launches ‘Technology First’ Approach For People With I/DD).
Last year, Ohio established the “Technology First Initiatives” and the Ohio Technology First Council, which will guide the expanded use of supportive technology for consumers with I/DD. These technologies include any product, device, or equipment—for example, remote monitoring and advanced sensors—that may be used to maintain, increase, or improve the functional capabilities of individuals with disabilities at home, in the community, or in the workplace. The Ohio Technology First Council will include 10 members, including the director of the Ohio Department of Developmental Disabilities (DODD), and director of Opportunities for Ohioans with Disabilities. (For our complete story, check out Ohio Executive Order Supports Integrating Supportive Technology Into I/DD Support Plans.)
In 2017, the Tennessee Department of Intellectual and Developmental Disabilities (DIDD) launched the first phase of the Enabling Technology program. Last fall, the program was expanded to include six supportive living technology vendors offering tele-caregiving, remote monitoring sensors, and specialized mobile applications. The state’s goal is to create new opportunities for independence and self-determination, as well as helping people live independently in the community (see Tennessee DIDD Expands ‘Enabling Technology’ Supportive Living Pilot Project).
For provider organization executives, how the “Technology First” designation affects their organizations will vary state to state. Generally, reimbursement to I/DD provider organizations does not change in most “Technology First” states. In many states, technology-enabled long-term services and supports are already covered by Medicaid under home- and community-based services (HCBS) waivers. Depending on the state, this may or may not include coverage of the cost of the technology for consumers when categorized as specialized medical equipment and supplies or assistive technologies. For example, a state Medicaid program may choose to cover the cost of motion sensors and cameras in a consumer’s home or a location tracking device for a consumer (see Medicaid Becomes the First Third-Party Payer to Cover Passive Remote Monitoring for Home Care: Policy Analysis and Consider Technology First: Technology Across the U.S.).
In addition, some states pay for selected technology costs. For example, Missouri Medicaid has reimbursed for remote monitoring technology installation, as well as the monthly monitoring services since 2012. Other states are using pilot programs to support provider organizations to deliver more tech-enabled care to small groups of consumers or providing additional information and education to consumers about the use of assistive technologies as a way to encourage their use. For example, Tennessee is conducting a pilot program, giving selected organizations funding for technology and tech-enabled support services for one year. After the first year, the provider organizations must be able to support the technology services without state funding.
What these state strategies really demonstrate is that there is a continued preference for consumer-directed, home-based care among payers, and that technology is an effective means of moving these goals forward. With continued cost pressures, a push for greater consumer choice, and a focus on clinical quality, virtual care is quickly becoming the rule, rather than the exception across the health and human service field. The question is, as in so many strategic challenges in health and human services, are I/DD provider organizations prepared to implement these technologies (see The I/DD Market Evolution)? For the provider organizations currently not prepared, this shift will require a change in the role of leadership, a new service culture, and new technology investments—requirements that are also being sped along thanks to the growing influence of managed care in the I/DD space (see I/DD & Managed Care? There Will Be Requirements).
For more, join us in New Orleans on June 3, 2019 for The 2019 I/DD Executive Summit. The summit’s keynote, “From Managed Care Planning To Execution – The Future Of Financing & Service Delivery Models For The I/DD Market,” will feature Josh Boynton, Vice President, Aetna Medicaid.