I believe the easiest and most effective way for managed care organizations to initiate providing services to Ohioan’s with an intellectual disability is through the ICF-IID program. But, just to be clear, I think our current public system is not ready to make that kind of jump for another 3 to 5 years. Other respected professionals in our field might even say 10 years. The main point is, my opinion is not a consensus view. I do believe however, when taking into consideration the change curve for any organization, the 3-5 year time frame gives providers just enough time to start adjusting to the transformational level of changes that would need to happen during this transition to managed care. This is also taking into consideration that in general I believe our system of disability services is behind in terms of how it connects with our modern day healthcare system, specifically in regards to health outcomes and electronic exchange or data capturing. Each agency can determine how far along they are on that path for themselves.
Aging Ohioans and Managed Care
First of all, the demographic of Ohioan’s with disabilities is aging like everyone else, and more are becoming eligible for Medicare. MyCare Ohio, a Medicaid and Medicare managed care program, is addressing the dual eligible population currently. Historically, SNFs and ICF-IID have often been seen as synonymous (accurate or not) so the capacity to coordinate Medicaid/Medicare for people who are living in a SNF or ICF-IID may be seen by many as a current capacity and strength of our Managed Care Organizations.
Operational Challenges: ICF-IID
I also believe that the ICF-IID program in Ohio has a few different pain points for the state, and this challenge, specific to the function and operation of the ICF-IID program in Ohio, creates an in-road for managed care. The first pain point has to do with expense. The ICF-IID program continues to go through rate adjustments and rate setting interpretations regularly, making it difficult to operate these kinds of programs. The rate, of course, has to do with the availability of monies to fund the program. Ohio has a comfort and confidence level in the use of managed care to address financial risk regarding funding Medicaid services. The second and third pain points for the state are network capacity, and outcomes. Currently the state of Ohio is getting too much attention, nationally, for having a high number of ICF-IID beds per capita compared to other states. Currently, the state is negotiating the downsizing of ICF-IID programs. Their requests are based on number of beds and a “%” of beds that need reduced in general. There is currently no strategy that is tying these reductions to poor performance or outcomes. Managed Care Organizations would address these matters by addressing the level of care (LOC) associated with ICF-IID services and authorizing, appropriately, people who have been assessed as needing that LOC. In order to address the abundance of providers in the network, managed care would collect quality data, as well as cost data. In turn, that data would specify agency quality and value And be used to set rates and reduce network levels if necessary.
Demographic familiarity (already understanding the customer and service), cost containment (capitated/risk plans), network capacity or development, and quality outcome measurements, would be the main reasons that Managed Care will be asked to add ICF-IID services as a benefit in the near future.
My last comment would be to also consider that, unlike other parts of the DD system in Ohio, ICF-IID services do not have local authority channels to consider, nor local match that is required. Those are not additional challenges to the system that I am bringing up, but rather clarifying who are the policy decision makers involved in considering this option.