At the same time that Medicaid long-term services and supports (LTSS) are moving to manage care models, the services for consumers with intellectual/developmental disabilities (I/DD) are moving in that direction as well. As we’ve reported before, 50% of consumers with I/DD receive their health and behavioral health benefits through Medicaid health plans—and 15% of those consumers have their LTSS services delivered via managed care models (see State Medicaid Programs With MLTSS: The 2016 OPEN MINDS Update, What Are The Major Provisions Of The 2016 CMS Medicaid Managed Care Final Rule?: An OPEN MINDS Market Intelligence Report, and VBR & I/DD-The Wave Begins).
So what does that mean for specialty provider organizations serving the I/DD population? I got a first-hand perspective last month from Olivia J. Garland, Ph.D., Vice President State Consulting and Solutions Architecture for Individuals with Intellectual & Developmental Disabilities, Optum Government Solutions, and Lilli Correll, Vice President, Product Development and Solution Design, Optum Behavioral Health at the The 2018 I/DD Executive Summit. In their opening keynote address, Managed Care & The I/DD Population: The Health Plan Perspective On The Strategic Challenges & Partnership Opportunities In A New Market, they shared their perspectives on the changing market as Optum prepares to launch a major I/DD initiative in early 2019 (see Optum’s SPARK Initiative Aims To Help Individuals Live A Self-Directed Life).
Much of what they see as fundamentals of system change should be no surprise to organizations currently working with health plans—more provider network development, service authorizations, and performance metrics. Or as Ms. Correll explained, “What happens when you come to managed care? You can anticipate there will be authorization requirements. Also MCOs will have their own contracting requirements that many smaller provider organizations aren’t prepared for. As provider organizations become more sophisticated, there will be room to move to more shared savings agreements, with the provider organizations overseeing the risk, but to do that they must institute and manage quality control metrics. There will be requirements.”
But there are some twists. Managing HCBS services and the creation of service plans in conjunction with health plans will be a system change. In addition, health plans are looking for a best practice model that integrates care coordination with LTSS, medical, pharmacy, behavioral health, and social services. For the provider organizations currently not on this path, this shift will require a change in the role of leadership, a new service culture, and new technology investments.
The good news is that there are many opportunities to develop innovative solutions. Dr. Garland’s advice: be sure to understand that health plans are looking for partnerships, and that getting over the fear of “being replaced” is key to moving the field to better I/DD services. She said, “The point of the new approach is that we want to be a partner, and we don’t want to come to the table with ‘the answer.’ We want to supplement what we do know how to do, and work with states and providers organizations, and individuals. We, the managed care company, can’t move the system forward without the people that do the work. We need you to engage the infrastructure and make sure you are a part of it.”
What are those possible opportunities? Specialty health homes; intensive care coordination models; and programs supporting independence by maximizing employment and housing opportunities are just a few of the many opportunities.
What should executive teams of organizations serving the I/DD population expect? First, conduct a managed care “readiness assessment” and address the issues found—this may mean improving competencies for processing authorization requirements, electronic billing, credentialing; or gaining the ability to participate in a range of reimbursement arrangements—to name a few potential issues. Most of these competencies require new technology functionality, a change in staff functions and culture, and a nimble transformational leadership team. As markets move towards more managed care, more value-based reimbursement, more consolidation, and more competition—executive teams should consider alliances and partnerships with other providers to share investment costs and/or affiliation with a larger entity who can perform managed care functions. The path to sustainability will be different for every organization—but finding the path is key.
For more on the continuing integration of specialty care in health plans, join us at The 2018 OPEN MINDS Management Best Practices Institute in Long Beach, California on August 15 for the session “Integration, The End Of The Carve-Out & The Importance Of Financing – The Health Plan Role In Facilitating ‘Whole Person’ Care,” featuring Devan J. Cross, President, MHN, A Subsidiary of Centene.