There is a moment right now, today in Ohio, that agencies can decide to be a part of defining history or allowIng history to define them. Many transistions in health care have already begun, and some systems are well into transformation. Hospitals, skilled nursing, foster care, community mental health; these are services that have either started on their new path or are well down the road of implementation already. For this article, I am talking specifically about agencies who serve and support people with developmental disabilities. This is the sole group left who can still be a part of defining their future more directly.
The current budget, passed in June, took the last steps toward a fully integrated managed care system for Ohio Medicaid. People with a developmental disability are now being given the opportunity for voluntary enrollment into a Medicaid managed care plan.
What makes right now so special for agencies serving people with disabilities is that they are not part of the network of managed care services. ICF, and IO Waiver programs are still carved out of the Medicaid managed care system in Ohio. Unlike doctors, and nursing home and behavioral health providers, the relationship with a disability agency can be without the dynamics of payer to payee. Agencies serving people with disabilities can be active partners with managed care organizations and find ways to support the MCO’s pursuit of NCQA’s HEDIS outcomes and performance measures. Through the pursuit of quality outcomes from both entities, and finding ways to support each other’s pursuit of those quality measures, services for people with developmental disabilities will be better.
For instance, the network of medical professionals that provide dental or behavioral health services to people with a developmental disability will expand from where it is today. The current state of that network is very poor, but the current, fee for service, Medicaid system is ill equipped to generate professional expansion regarding the specialization of these two services to people with a developmental disability. Imagine that a mechanism is in place, for people with a developmental disability or their advocates/guardians, that gives them a voice regarding a lack of professionals to meet the services promised to them under their insurance policy. Imagine being able to choose a different network for insurance coverage because you know a company has been able to create more accessible capacity. An expanded network for dentists and behavioral health providers would be very helpful to community based social service agencies trying to support those in the community.
In regards to managed care, I think this ideal partnership is beneficial to them and their drive to meet specific, defined outcomes. One of the biggest challenges in health care, in general, is compliance with treatment or preventative measures. In a traditional relationship, that you or I might have with our doctors, we may see a physician 3-4 times a year, or more, assuming we have a condition being treated. Presumably we will see them even less if there is not a current treatment plan in place. Though some HEDIS measures can be more challenging, there are many that fall into, what I would call, standard practice and expectation for a good IO Waiver provider. HEDIS includes measurements such as meeting with your doctor for regular exams and screenings, getting a flu shot, dental cleanings as well as compliance with cholesterol and diabetes treatments. These are just to name a few of the many quality measurements that agencies who support people with developmental disabilities are already engaged with and doing. All that is missing for the moment is a more direct link and relationship with managed care plans so that information is shared and activities can be coordinated to a degree.
The time to begin these talks and relationships is now. Both groups are new to each other in regards to the role that each can and does provide to a person with a developmental disability. The opportunity for provider agencies to leverage supports and tools from a managed care plan is significant, only improving their services and ability to create separation from competitors. Likewise, managed care organizations would be quite capable of creating informed health advocates (Agency Providers) that could interact directly with medical network providers at the exact time of service, allowing them to draw lines of separation between other managed care plans.