“You are either at the table or you’re on the menu.”
I’ve had that phrase stuck in my head since I presented at the “Shaping the Conversation Around I/DD Services, Quality and Value” symposium in Chicago a few weeks ago at which a group of 24 stakeholders were convened by the Council on Quality and Leadership (CQL), the Illinois Institute on Public Policy for People with Disabilities, and Mosaic. We spent the day in deep, vigorous discussion about the need to understand and manage the drivers of the intellectual/developmental disabilities (I/DD) market.
My session, Looking Across The Industry: What Are States Thinking About I/DD and Value-Based Reimbursement, posed three big questions for provider organizations to ask themselves:
- Are we achieving our core objectives and mission in this current market?
- Is our organization sustainable in the short-term?
- Is our organization sustainable in the likely future market landscape?
The I/DD market hasn’t evolved as quickly as the physical health, behavioral health, and children’s services market (see The I/DD Market Evolution), but one place that it has started to catch up is value-based reimbursement (VBR). Many of the provider organizations I speak with assume that VBR is far down the road, but it’s much closer than many realize (see VBR & I/DD-The Wave Begins). This presents a pressing need to understand value-based quality measures currently in use, identify potential key measures that would apply for I/DD along with the data to support them, and outline a roadmap for the evolution and dissemination of the measures. And this presents yet another road of questions for provider organizations:
- What do consumers want?
- What will health plans pay for?
- How will system restructuring change competitive advantage?
- How will technology change the value proposition?
A quick review of the main drivers highlights a few points of focus for identifying the implications for provider organizations and payers of I/DD services:
The impact of managed care and VBR demands an emphasis on business analytics, outcome measures, and service standards in a way we have never seen before. Unlike the behavioral health space, where symptom management can be measured with depression scales, acute care visits can be reduced, housing retention can be assessed, and sobriety can be tracked, much of the I/DD service delivery is expected to be lifelong and delivered to clients who may be nonverbal or limited in their communication abilities. This illustrates yet another round of questions in need of answers:
- How do providers capture their feedback when much of the I/DD world is about building relationships?
- How do you measure the value and depth of a relationship? As evidenced by what? By whom?
- What is the dollar value of that relationship?
- Do payers have a right to ask simply because they are paying for it?
These questions gave rise to one popular sentiment among the attendees—”it’s important not to lose success stories in data dashboards.” But how do organizations hold their mission while aiming to achieve sustainability in a new payment model?
When we think about the compensation continuum, physical health is largely seated in the right side of the scale, with behavioral health somewhere near the midpoint, and I/DD services just beginning the slide from the left to center. One of my colleagues at the symposium raised an interesting point. To move to bundled or episodic payments, we first need to define the beginning of the episode. For an injury or a surgery, such as a knee replacement, that starting point is obvious. The questions continued:
- When does the “chronic bundle” begin? Is it at birth? Is it at the point of out-of-home placement?
- What are the defined outcomes to measure?
- What is the value proposition in I/DD services, in lifelong care, as we move away from traditional payment models?
Executives concerned about measuring quality and value need to come together and set the stage for what is to come—more managed care in the I/DD space (see I/DD & Managed Care? There Will Be Requirements). What lessons can we learn from the best practices that have emerged over the 40 years of community-based services and bring those forward into the emerging future? Stay tuned.
For more, join OPEN MINDS Chief Executive Officer Monica E. Oss and OPEN MINDS Advisory Board Member John Talbot, Ph.D. on December 19, 2018 for their 1:00 p.m. (EST) Webinar, Collaboration, Connectivity & Complexity: Building A New Leadership Framework For A Value-Based Market.