Full State Managed Care Review: All 10 Current Programs
Is Provider-Led Care the Future of Managed Care Programs?
THE VBP Blog
[July 30, 2020] Across several months and multiple blogs, we have covered all ten states that feature managed care programs for the Intellectual and Developmental Disabilities population. We saw a wide range of successes, type of programs, and different phases of roll out. With each, we broke down the state’s managing entity, how many consumers were affected, the role of case management, the roll out approach, and more. To make things a bit easier to compare, we also compiled a chart and a presentation [Full State Review Managed Care IDD ] for you to reference.
Managing Entity Variations
When we did our review of the first six states, there was an overwhelming majority of them leaning on Multi-State Commercial MCOs. As we broke down the final four, we saw a range of entity options but mainly state/local options. The main downside to a regional approach is lack of consistency moving from one area to another (i.e. North Carolina & Michigan). On a positive note, it does allow for a person-centered approach and if rolled out slowly, like in Wisconsin, mistakes can be learned from and standards can be set. The Multi-State MCO approach does prove to work as well if the state structure is designed well, as we saw in Tennessee and Texas.
Case Management Can Take Many Forms
Ten states and essentially ten different ways to handle case management. The winners of the group are Tennessee and Wisconsin. Tennessee provided Supports Coordination through the MCOs and set 10-day and 30-day goals giving them benchmarks to ensure they provide the best possible care. Wisconsin took the more unique approach with the IRIS (Include, Respect, I Self-Direct) Program, putting the choices back in the hands of the consumers. Iowa saw the worst results with their last-minute decision to require MCOs to contract with existing care management entities for the first year, leaving both consumers and providers confused and frustrated.
For states that gave themselves time to roll out a program, success was very likely. We saw this across Kansas, Tennessee, Wisconsin, and currently New York who has been rolling out their program since 2018. Wisconsin launched county by county, providing flexibility to adjust and learn as they went. This approach is unique to the state and the results have been incredible. New York started with a voluntary enrollment for the past 24 months and has seen over 100,000 sign up, giving themselves the space to do enrollments correctly. While most states have taken on this phased approach in some form, the odd ball is Iowa, who launched all at once, causing major issues.
Provider-led Care is the Future
Our final blog covered North Carolina and New York, states that are taking some of the more unique approaches with a whole-person approach. This gives individuals more options and focuses on enhancing care coordination and service plans while providing more assurance their needs will be met. Provider-led care can take time, which can be a downfall, but offers an extremely high quality of life.
Download the free presentation covering all 10 states here -> Full State Review Managed Care IDD
As we wrap up covering the ten states with managed care I/DD programs, there is still more information to be learned as these programs develop. Clearly, there is no one-size-fits-all program and we are excited to see what other states come up with. We are most excited about the provider-led approach because it has a consumer-driven focus that leads to the highest quality of life for individuals with I/DD. Undoubtedly, we will see more states take on managed care I/DD programs and we will continue to cover new developments in all state programs that ideally strengthen the mental, physical and emotional well-bring of their communities.
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About the Author
Fady Sahhar brings over 30 years of senior management experience working with major multinational companies including Sara Lee, Mobil Oil, Tenneco Packaging, Pactiv, Progressive Insurance, Transitions Optical, PPG Industries and Essilor (France).
His corporate responsibilities included new product development, strategic planning, marketing management, and global sales. He has developed a number of global communications networks, launched products in over 45 countries, and managed a number of branded patented products.
About the Co-Author
Mandy Sahhar provides experience in digital marketing, event management, and business development. Her background has allowed her to get in on the ground floor of marketing efforts including website design, content marketing, and trade show planning. Through her modern approach, she focuses on bringing businesses into the new digital age of marketing through unique approaches and focused content creation. With a passion for communications, she can bring a fresh perspective to an ever-changing industry. Mandy has an MBA with a marketing concentration from Canisius College.