At the annual ANCOR Conference, Medicaid, specifically Managed Care, was a hot topic of conversation. We’ve heard this echoed at many conferences this spring as nearly all 50 states are having some discussion about moving the I/DD system into Managed Long-Term Services and Supports (LTSS). I attended two sessions at the ANCOR conference focused specifically on the experience of providers either operating a managed care program or providing services under managed care. Below are some lessons learned based on presentations from Kansas, Iowa, and Pennsylvania.
In a session titled “A Relationship On the Rocks: Managed Care and I/DD Services,” I heard from Kansas and Iowa, the two states that have placed their entire I/DD service system under managed care so far. In Kansas, the experience to date has not met the program’s stated promises according to the presenter, a Kansas provider. The shift to managed care promised: higher employment outcomes (mixed results); increased access to behavioral health (hasn’t happened yet); better health outcomes (stopped the health homes when the enhanced match ended); increased administrative efficiencies (more due to working with three MCO’s); end to the waiting list (unfortunately it has gone up and with less transparency); and, protection from future cuts (experienced a 4% cut). Speaking from experience, the Kansas policy-related recommendations for other states were:
- advocacy early and often;
- conduct a real pilot first;
- understand what the expected outcomes are for LTSS;
- maintain an understanding of the state budget; and
- focus on people, not managed costs.
In Iowa, managed care was rolled out very quickly, and in the presenter’s view, too quickly. In addition, the implementation did not anticipate problems. Iowa, through the Governor’s office, was able to implement managed care without legislative or stakeholder input which certainly heightened anxiety over the speed of the process. The presenter mentioned that providers in Iowa are hoping for some rate stabilization and efficiencies through the process, and are still early in the implementation stages. The presenter offered some great advice for the provider executive facing managed care – be prepared by:
- being ready for a heavy emphasis on knowledge of data and performance (electronic records can help);
- knowing there will be a focus on health outcomes like BMI and diabetes management;
- knowing your costs;
- investing in more staff to ensure billing and finances are efficient;
- understanding the Provider Manual and contracts; and
- being prepared to bill from multiple MCOs (again, using an electronic record can help).
In a second session, a provider from Pennsylvania presented on a small managed care program they operate directly for adults with autism. This 1915 (a) program is unique in the I/DD field (it is funded like a PACE program), providing a capitated per member per month payment to the provider who in turns manages both healthcare and LTSS. This Pennsylvania agency reported positive results in personal outcomes in health, employment and volunteering, and independence. The agency also reported new success operationally.
There was certainly interest expressed at the conference from other provider association executives seeking new and innovative models to manage and finance service delivery. I won’t be surprised if we see more twists as an increasing number of states seriously explore managed care.