Populations with chronic conditions and complex needs are getting more—and different—attention these days. The consumers with intellectual and developmental disabilities (I/DD) are no exception. Of the more than 16 million individuals who are diagnosed with an I/DD (see The Intellectual & Developmental Disability Consumer Health Insurance Market: An OPEN MINDS Market Intelligence Report), an estimated 40% have a co-occurring mental illness (see The Support Needs Of People With I/DD And Co-Occurring Mental Health Challenges). And with the start of the pandemic crisis, the overall chronic disease overlay of this population is responsible for a higher coronavirus death rate among those with I/DD (see Those With I/DD Are More Likely To Die From COVID-19 Than Those Without I/DD).
These consumers are significantly more likely to have chronic health conditions compared to the general population, including gastrointestinal disorders, sensory impairment, hypertension, and cardiovascular disease (see The State Of The Science Of Health And Wellness For Adults With Intellectual And Developmental Disabilities); 45% have three or more chronic conditions (see Health Care Coverage For Consumers With An I/DD – The Trends & The Future). The higher support needs and greater resource use of the population have commanded the attention of payers.
At the same time, a new demographic challenge is emerging, as Michael J. Hammond, MSM, vice president of product strategy and partnership development at Optum outlined in his keynote address at The 2020 OPEN MINDS Strategy & Innovation Institute, The Future Of Community-Based I/DD Services. Consumers with I/DD are living longer—approaching a life expectancy similar to the general population, ranging from the mid-50s for those with severe diagnoses, to the 70s for those with less severe diagnoses (see People With Intellectual And Developmental Disabilities Growing Old: An Overview). Over one million of them have caregivers over the age of 60—meaning they will outlive their caregivers and need more government-funded support services.
These demographics are increasing the number of consumers with I/DD in the service system—where state and county budgets are funding support services. In addition to more consumers requiring services for a longer period, government agencies face a number of issues specific to supporting the I/DD population. Providing access to medical and behavioral health services, access to housing and transportation, the supply of the direct care workforce, the emerging use of technology, and the increasing legal and ethical mandate for community-based services top the list. To address these issues, government agencies are increasingly embracing the use of managed care (see Medicaid Managed Long-Term Care Models For The I/DD Population: An OPEN MINDS Market Intelligence Report). This is a trend that will likely accelerate as the pandemic health crisis becomes a pandemic economic crisis.
So, in this mix, what are the new opportunities for provider organizations serving the I/DD population? Mr. Hammond outlined three emerging areas of focus where provider organizations can gain market advantage in systems (whether managed care or not) focused on value. The first—focusing on integrated services that ensure quality of life and moving from a provider of a service to the coordinator of all services. The second—embracing person-centered planning with service options that are flexible and reinforce consumer choice. And, lastly, thinking about the goals to increase value—improving service performance metrics and reducing the use of unnecessary or duplicate services. Each area of focus needs to be seen through the lens of an aging consumer population with more chronic behavioral and medical conditions.
In addition to the post-crisis market factors affecting the greater health and human service field, provider organizations serving consumers with an I/DD will also have to address the effects of the changing demographics to find a path to sustainability. The organizational competencies required to succeed in a managed and value-driven environment—including enhanced technology, data interoperability, and new administrative process—are just one part.
More difficult is innovating around new payer and consumer preferences and expectations for health and support services. Innovation demands new thinking about the needs of customers and capital for expansion and/or new service line development. For more on service line development and innovation, listen to these past web briefings from my colleagues and OPEN MINDS Senior Associates Paul Duck and George Braunstein, and OPEN MINDS Vice President Richard Louis, III.
- Aggressive Business Development Strategies – Adding To The Top Line With Breakthrough Services – An Overview
- Service Line Portfolio Management In Crisis Recovery Planning – Making The Tough Decisions
- Increasing Your Service Volume – Creating A Referral Development Crisis Plan
And for examples of provider organizations with innovative I/DD programming, check out these resources in The OPEN MINDS Industry Library:
- The Future Of Residential Treatment: How Technology & Innovative Program Models Are Redefining Service Delivery Models
- New Directions & New Business Models: Building A Wholistic Care Model For The I/DD Population
- Tennessee’s Long-Term Services & Supports (LTSS) Program: Employment & Community First (ECF) CHOICES
- The OPEN MINDS Integration Summit: New Models For Primary Care, Behavioral Health & Social Service Integration
- A Guide To Self-Direction In The I/DD Market: Incorporating Consumer Self-Direction Into Your Program Model
- Leveraging Technology To Improve Services For Consumers With I/DD
- Innovative Community-Based Care Models For Consumers With Complex Conditions
- Getting Ahead Of The Curve: Entrepreneurial Approaches Employed By Leading I/DD Providers
- Devereux Advanced Behavioral Health: An OPEN MINDS Organizational Profile
- Bancroft: An OPEN MINDS Organizational Profile
And for even more on supporting complex consumer populations, join us on August 26 at The 2020 OPEN MINDS Management Best Practices Institute for the session, Specialty Primary Care Models That Work For Consumers With Complex Needs, led by OPEN MINDS Senior Associate Ray Wolfe, J.D.