Hello from sunny Long Beach, California, where we kicked off OPEN MINDS Management Best Practices week with the executive seminar, Is Your Organization Managed Care Ready? An OPEN MINDS Executive Seminar On Provider Organization Planning & Positioning For Success, featuring OPEN MINDS Senior Associate Richard Louis.
As the latest numbers show, 77% of the insured population in the U.S. is enrolled in managed care (up from 74% in 2014), and fee-for-service reimbursement is quickly disappearing as a financing model across all populations and services (see U.S. Population Enrolled In Managed Care, 2011-2016: An OPEN MINDS Reference Guide). But there are still ten states with no Medicaid managed care and many others have traditionally excluded specific services (like long-term services and supports), or vulnerable populations (like children in foster care or consumers with intellectual/developmental disabilities), from their managed care programs. This has left many specialty provider organizations behind in positioning their organizations to succeed in a managed care environment.
Mr. Louis tackled this challenge in today’s seminar, advising executives of specialty provider organizations to ask four questions as they think about their managed care strategy:
- Does my organization have the proper revenue mix and service lines for continued sustainability in a managed care environment?
- How do I change my revenue mix to rely less on county funding and leverage other non-government-based funding sources?
- Are there additional opportunities for growth in my changing marketplace?
- Do I have the proper infrastructure to effectively deliver services and meet payer expectations under managed care?
Finding the right answer to any of these questions will be driven in no small part by finding the right revenue mix and service line diversification on a path to delivering “what managed care organizations (MCO) need.” This is part of a good risk-reduction approach that involves spreading assets across a mix of service lines, consumer groups, and payers. In this process the organization should consider creating new service lines that meet the needs of new markets even if the service line is out of your realm of experience (see Diversification & New Service Line Development). And “what MCOs need” must be at the heart of any managed care readiness program.
Mr. Louis explained that while exploring new contract opportunities for a non-profit community mental health client in Southern California, he met with the CEO of a Managed Services Organization (MSO) that managed a large number of Medicare Advantage lives, and was interested in expanding his provider network. What experience was that MSO interested in? Mr. Louis explained:
He asked if the provider had any managed care experience. Specifically he asked about 24/7 single point of access for new referrals, knowledge of continued stay reviews, customer satisfaction outcomes and the availability of on-site case managers for coordination of care and proactive discharge planning. In this case I said yes, although I recognize that the answer is likely “no” for many organizations that have traditionally operated within a county provider network and have little or no experience serving health plan/MCO members and families.
Service line expansion into this space meant taking a step back to evaluate care delivery and staff to support roles for contracting, reporting, intake/admissions, case management, and treatment services that MCOs expect from a contract provider organization. But it’s also key to remember that a different meeting with a different MCO would have unveiled different needs and solutions.
My final takeaway? It is clear that in an evolving managed care landscape, provider organization positioning for success, growth planning, and managed care readiness is essential for provider organization sustainability.
To evaluate your organization’s readiness for managed care, check out the newly released OPEN MINDS Managed Care Competencies Assessment, an online, self-assessment for executives of health and human service provider organizations looking to examine their organizational competencies for optimized performance in the managed care market. And for more live coverage from Long Beach this week, tune in tomorrow when we report on the first day of The 2018 OPEN MINDS Management Best Practices Institute—be sure to check out our ongoing live and archived coverage of the event on Twitter @openmindscircle – #OMBestPractices.