I’ve been thinking a lot about the big takeaway from our 2020 OPEN MINDS I/DD Executive Summit. Which of these changes that we discussed will drive strategy? The changing intellectual and developmental disability (I/DD) consumer population—with more health care co-morbidities and increasing age? The clinical and financial struggles of I/DD-focused specialty provider organizations during this pandemic crisis? More managed care and value-based reimbursement financing services for this population? The consumer and caregiver focus on person-centered planning? Or the health plan focus on the “total cost of resources” for these consumers—and preference for organizations with a “whole person” integrated approach to services?
After going back and forth, I’ve arrived at the conclusion that it is the synergy of these market factors that is the key driver. These five “big changes” together will reshape the characteristics of a “successful” organization in the I/DD sector in 2021. Think of it this way. The changing demographics of the I/DD consumer population (see Demographics As An I/DD Market Opportunity) will increase the number of consumers seeking services and the cost of those services—at a time when we are headed into a national economic recession and very tight state and local budgets. Governments will likely (if the past is any indication) turn to managed care entities to manage their service delivery systems. And as a result, specialty provider organizations’ payer relationships will shift from government to health plans—at a time when these organizations are already challenged by the financial impact of the pandemic crisis.
The preferences of health plans are different from those of the government. Health plans are looking for specialty provider organizations that can address two issues simultaneously—integrated approaches to whole person care that are focused on improved consumer experience and lower total cost of care—and also address consumer and caregiver demand for person-centered approaches to planning those services.
These many simultaneous and synergistic changes are going to require some “out of the box” thinking (and capital). What does the “winning” program model look like in the future? That question was answered in the keynote address, The Future Of Community-Based I/DD Services, at The 2020 OPEN MINDS Strategy & Innovation Institute, where Michael Hammond, vice president of product strategy and partnership development at Optum, gave an information-rich briefing on the relevant market factors.
The changing demographics are no secret. Comorbidities, an aging consumer population, and an aging caregiver population (see Demographics As An I/DD Market Opportunity) are going to change the demand for services and the cost of services—largely paid for by government. Whether the government payers use health plans to administer these benefits or not, the focus is, necessarily, on performance. The National Association of County Behavioral Health & Developmental Disability Directors (NACBHDD) survey of its member organizations around the country found a focus on these factors (second to “none”) including access to behavioral health, behaviors, independence, and contact with the criminal justice system.
State-sponsored HCBS quality measurement is on the increase, as Mr. Hammond cited. According to the Kaiser Family Foundation, a total of 51 states have at least one quality measurement in place (see Key State Policy Choices About Medicaid Home And Community-Based Services). Forty-eight states currently measure quality of life among beneficiaries and 42 measure community integration. Long-term services and supports rebalancing measures are implemented in 17 states.
And we’ve seen similar trends in health plans—including UnitedHealthcare’s Community Plan of Tennessee Employment & Community First CHOICES program, which includes an integrated support team and provides a holistic approach to consumer care for the I/DD population, with a focus on community living and finding employment opportunities (see For Success With The I/DD Population, Employment Matters and Tennessee’s Long-Term Services & Supports (LTSS) Program: Employment & Community First (ECF) CHOICES). And Optum’s Integrated Solutions for Individuals with Intellectual and Developmental Disabilities that focus on community inclusion, self-determination, life satisfaction, and improved health outcomes (see Self-Determination In The I/DD Market: Incorporating Consumer Self-Direction Into Your Program Model).
The 22 states that already have some form of Medicaid managed long-term services and supports are likely to be first to move to using managed care programs for I/DD service management (see Medicaid Managed Long-Term Care Models For The I/DD Population: An OPEN MINDS Market Intelligence Report). And for executive teams in those states, the question is what are the elements of a program with a high likelihood of success. My checklist?
- “Fits” in an integrated (medical, behavioral, supports, social) system—with care coordination and data interoperability capabilities.
- Is framed in a person-centered approach.
- Has measurable performance from a consumer and payer perspective.
- Has efficient managed care competencies (see The OPEN MINDS Managed Care Competencies Assessment).
- Accepts reimbursement based on performance (see The OPEN MINDS Value-Based Reimbursement Readiness Assessment).
All of these elements are likely to be required in programmatic approaches that “win” in the new year.
If this sounds like a tall order, I think it is. Of all the specialty care sectors, I/DD service provider organizations are going to be one of the sectors where the most change will be required for future sustainability and success. Both consumers and payers are looking for “something different” from those provider organizations—and what lies ahead is a period of market disruption beyond just the end of the pandemic crisis. This shift in service reimbursement and service delivery will happen at different times in different states. States with better budget situations and more of a historical commitment to service citizens with disabilities will likely be the last. But I think the synergy of these market factors is going to create a “perfect storm” for provider organization executive teams. Every competency—leadership, financial resources, marketing strategy, clinical expertise, and more—will be challenged by simultaneous changes in expectations and financing.
I was trying to think of how best to describe the challenges ahead for these executive teams. As a movie buff, what popped to mind was the statement about Ginger Rogers, the American actress who was the frequent dancing partner with Fred Astaire in movies like Follow The Fleet, Swing Time, Shall We Dance, and Top Hat. It was often said that she did everything he did—just backwards and in high heels. Asking I/DD organizations to make this evolutionary change in their market position and services lines is no simple tasks—and will be quite foreign to many management teams and boards of directors. But for those who are strategic, it is possible to dance backwards.
For even more on preparing for I/DD market changes, check out these resources in The OPEN MINDS Industry Library:
- 68% Of I/DD Provider Organizations Closed One Or More Service Lines By April 2020 Due To Pandemic
- Those With I/DD Are More Likely To Die From COVID-19 Than Those Without I/DD
- Telemedicine Triage Kiosks In Group Homes Helped Reduce Emergency Department Visits By 11% Among New Yorkers With I/DD
- Children With I/DD Have Double The Health Care Costs Of Children Without I/DD
- Ohio Revised Settlement Agreement Allows Consumers To Choose Between I/DD ICF & HCBS Waiver Services
- A Snapshot Of The Changing Landscape For Managed Care & I/DD
- Health Care Coverage For Consumers With An I/DD – The Trends & The Future
- For Success With The I/DD Population, Employment Matters
- Number Of People On I/DD HCBS Wait Lists Rose Nearly 12%
- Colorado Cuts I/DD Waiting List By 61% From 2013 To 2019
And for even more on serving complex consumer populations, join us for The 2020 OPEN MINDS Care Innovation Summit: Solving The Problem Of Access For Consumers With Complex Care Needs, led by OPEN MINDS Senior Associate Paul M. Duck on August 25.