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By Sarah C. Threnhauser

  1. $65+ billion was spent on I/DD services by federal, state, county, and local governments
  2. 10 states have moved their long-term services and support programs for the I/DD population into managed care
  3. From 2013 to 2015, institutional spending fell over 11%—with a reduction in placement of individuals with I/DD in facilities with more than 16 individuals
  4. 70% of individuals with I/DD live with a family member, 16% live along, and 14% live in a supervised residential facility
  5. 24% of family caregivers are over the age of 60

So what do these “facts” tell you about the market for services for individuals with intellectual/developmental disabilities (I/DD)? They paint a picture of a changing, and challenging, market. Managed care is coming to an I/DD landscape that is moving from institutional service delivery to community-based models—at a time when many natural caregivers are aging out. This shift brings with it many “expected” business challenges. The executives of provider organizations serving this consumer population will need new administrative competencies in admissions and finance, in revenue cycle management processes, in marketing, and in payer contracting and referral development strategies. But beyond administrative infrastructure, there is also the need for a fundamental redesign of service delivery capabilities. The “next level” work is responding to the service system issues by developing more and different community-based service and support options.

This strategic challenge was the topic of The 2018 I/DD Executive Summit session, The Shifting I/DD Marketplace: The Implications Of Moving From Fee-For-Service To Managed Care & Value-Based Reimbursement, led by OPEN MINDS Senior Associate Ken Carr, and featuring Cindy Mahan, Chief Executive Officer, Friendship Community Care; Jay Nagy, Chief Executive Officer, Advance Care Alliance; and Richard Edwards, MS, Chief Program Officer, Community Based Care, LLC. The primary focus on the day was answering this question: How should executives position their organizations for sustainability in this new risk-based, community-focused market? The central theme of the recommendations from the executive panel was to develop scalable community-based service lines that are valuable to both payers and consumers—and profitable for the organization.

The panelists spoke about the changes in the states where they currently operate—Arkansas, New York, and North Carolina. Ms. Mahan spoke about the establishment of “Provider-Led Arkansas Shared Savings Entities” (PASSEs)—”organized care” models for I/DD and behavioral health populations that are partially owned by health plans and providers. Mr. Nagy spoke to the changes in New York that created seven care coordination organizations out of 300+ provider organizations. Mr. Edwards spoke of the development of alternate payment methodologies for I/DD services in North Carolina. Despite the variations in the policy decisions and system designs in each state, what they shared was a common strategic demand—community-based, consumer-centric services where reimbursement is tied to value. A new and tall order in the I/DD market.

The strategic questions for executive teams serving the I/DD population are: What will the service system look like in their particular state or county? How will home- and community-based waivers affect the demand and payment for specific types of services going forward? What measures of performance are important to the state, the county, and/or the health plan? What is the “right service package” of services for a market focused on self-determination and value? For more on building a new care model for a new market, here is a curated list of resources from the OPEN MINDS Circle Library, addressing this important market, and the dynamics changing it.

  1. Strategy In The I/DD Market
  2. The Future Of IDD Is In The Home
  3. VBR & I/DD-The Wave Begins
  4. What’s Holding Up Community-Based I/DD Services?
  5. A Tale Of Two Community-Based Program Models
  6. Disruption (& Strategic Planning) Come To The I/DD Space
  7. Innovation In The I/DD Market Space
  8. The I/DD Market Evolution
  9. What Does ‘Value-Based’ Look Like In The I/DD Field?
  10. Living In The Community-The Landscape For Adults With I/DD

To learn more about innovative programming, join Annie Medina in Long Beach, California on August 14 for the Designing & Implementing Innovative Treatment Programs: An OPEN MINDS Executive Summit.

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