CQL | The Council on Quality and Leadership

New Report Offers Guidance In The Move To Managed Care

Posted 7/31/19

By Carli Friedman | CQL Director of Research
cfriedman@thecouncil.org

While Medicaid managed care has existed for decades, it has not been commonly used in long-term services and supports (LTSS) of people with intellectual and developmental disabilities (IDD). However, this is slowly beginning to change. As Medicaid managed care starts to expand into the IDD LTSS system, evidenced-based quality standards and guidelines about managed care provision for people with IDD are more critical than ever.

To confront these issues, CQL | The Council on Quality and Leadership, The Institute on Public Policy for People with Disabilities, and Mosaic have held recurring symposiums with dozens of thought leaders in the healthcare and long-term services and supports (LTSS) industry, including service providers, industry associations, managed care organizations, and other stakeholders. This first of these symposiums occurred in October 2018, and resulted in the report 'Building The Framework For IDD Quality Measurement.'Download MMC Guidance Report

The most recent symposium, which took place in March 2019, aimed to develop a common understanding of value-based quality measures that are meaningful to people. The work group in attendance consisted of 30 stakeholders with expertise in government, disability rights, LTSS systems, quality bodies, managed care organizations, policy experts, and academics.

The symposium set out to provide guidance regarding quality services and supports for people with IDD to ensure that as managed care moves into the IDD LTSS field, the right outcomes are utilized – services and supports that maximize quality.

The result of the symposium is a detailed report titled 'The Move to Managed Care for Intellectual and Developmental Disability Services: Guidance for State Medicaid and DD Directors, and Payers,' which offers practical steps for pursuing the ideal service system for people with IDD, involving quality standards, workforce issues, best practices, buy-in, along with recommendations and resources.

Some key findings from the report involve the role that systems transformation, culture shifts, person-centered approaches, responsive services, technology, and business acumen can play in the shift towards managed care. The report also details a number of actions that can be taken to attain the ideal service system, such as establishing universal quality standards, cultivating buy-in from stakeholders, and providing more flexibility for MCOs from state agencies.

 

Symposium Attendees:

  • Julia Bascom, Executive Director, Autistic Self Advocacy Network (ASAN)
  • Joshua Boynton, MS, Vice President, Aetna Better Living
  • Joe Caldwell, PhD, Director of Community Living Policy Center, Lurie Institute for Disability Policy, Brandeis
  • Kathy Carmody, MA, CEO, Institute on Public Policy for People with Disabilities
  • Lindsey Crouse Mitrook, MBA, Director of Value-Based Care, AmeriHealth Caritas*
  • Stacy DiStefano, MC, Chief Strategy Officer, EVP Strategy & Business Development, lnperium, Inc.
  • Katherine Dunbar, BA, Vice President of Accreditation, CQL | The Council on Quality and Leadership
  • Alesia Frerichs, MS, Vice President of Member Engagement, Lutheran Services in America (LSA)
  • Carli Friedman, PhD, Director of Research, CQL | The Council on Quality and Leadership
  • Ann Hardiman, MA, President and CEO, New York Alliance for Inclusion & Innovation
  • Tamar Heller, PhD, Distinguished Professor and Department Head, Department of Disability and Human Development, University of Illinois at Chicago
  • Angela King, MSSW, President and CEO, Volunteers of America Texas
  • Erica Lindquist, MA, Senior Director of Business Accumen, National Association of States United for Aging and Disabilities (NASUAD)
  • Donna Martin, MEd, Director of State Partnerships & Special Projects, American Network of Community Options and Resources (ANCOR)
  • Mark McHugh, MSW, MEd, President and CEO, Envision Unlimited
  • Barbara Merrill, JD, CEO, ANCOR
  • Jay Nagy, BS, CEO, Advance Care Alliance
  • Tia Nelis, Director of Policy & Advocacy, TASH*
  • Patricia Nobbie, PhD, Disability Policy Engagement Director, Anthem
  • Kim Opsahl, JD, Associate Director, Indiana Division of Disability & Rehabilitative Services
  • Nanette Perrin, PhD, Director of Pathways and RCRS, Lifeshare, Sunflower Health Plan
  • Mary Kay Rizzolo, PhD, President and CEO, CQL | The Council on Quality and Leadership
  • Joshua Rubin, MPP, Principal, Health Management Associates
  • Tracy Sanders, MEd, Senior Director, Behavioral Health Medicaid Services, Optum
  • Jeri Schoonover, BS, CSO, Lutheran Social Service (LSS) of Minnesota
  • Erica Smith, BA, Chief Programs Officer, Volunteers of America Texas
  • Chris Sparks, MSW, President and CEO, Exceptional Persons Inc in Iowa
  • Linda Timmons, MA, President and CEO, Mosaic
  • John Tschida, MPP, Associate Executive Director for Research and Policy, Association of University Centers on Disabilities (AUCD)
  • Laura Vegas, MPS, Project Director for MCO Business Acumen, National Association of State Directors of Developmental Disabilities Services (NASDDDS)
  • Marlin Wilkerson, BS, Senior VP of Operations, Mosaic

*Consortium member but could not attend in person meeting.

 

 

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