Ask almost any physician in America what has been the most significant moment affecting the health care industry in the past half-century and they will say the rise of managed care and value-based purchasing models.
These payer concepts developed to respond to an industry where costs were rising dramatically and consumers were paying based on units of volume as opposed to desired outcomes. Most significantly, states turned to managed care organizations – insurance companies – in an attempt to maintain or cut Medicaid expenses which they saw as driving unsustainable growth in state budgets.
Why does this matter for HCBS?
If you’ve followed certain sectors of industry news over the past several years, you’ve seen that managed care has arrived at the doorstep of Home and Community-Based Services in several states, with the results in many cases resembling the houseguest equivalent of the Tasmanian Devil as opposed to Mary Poppins.
States have turned to managed care for HCBS for the same reasons as health care: costs are rising, the outcomes demanded by advocates continue to be out of reach for too many, and policy makers and political leaders don’t understand why, so they turn to “experts” who promise to solve their problems. However, as a recent report from ANCOR stated, state leaders forgot there is no private-payer equivalent in HCBS, and with so many critical differences between health care models and community-based supports, the managed care organizations fell woefully short of the financial and service outcomes they promised to deliver. In states like Iowa, the actual outcomes were massive upheavals with thousands of people and providers unsure of whether essential supports would continue to be covered.
Experiment over?…Not so much
Despite the catastrophic failures, the prospect of managed care continues to be a very real issue for HCBS providers, as certain positive outcomes have been identified and state leaders continue to look for solutions to address the fiscal issues in human service budgets.
Due in large part to the strong partnership and relationships maintained between the provider industry and state regulators, the prospect of managed care for HCBS has not yet been broached in Minnesota. Yet, Minnesota faces the same challenges and trends of other states: growing Medicaid expenditures taking over a larger share of state budgets, increasing state investment needs in other politically expedient areas, and a highly complex field policy makers don’t fully understand.
As a trade association, it is absolutely essential for ARRM to engage in this potentially monumental issue to ensure members are educated, and to be at the table with strong position statements and research findings to share with stakeholders and inform all conversations related to managed care.
What’s next for ARRM
In the next few months ARRM will launch a free educational series on managed care through the Service Innovations Committee for members looking to expand their knowledge. ARRM committees will also take steps to develop clear positions on managed care concepts, and the organization will become more involved with established stakeholder groups, such as Altair.
For several years, a group of providers has already been diving into this issue, forming the collaborative Altair, an Accountable Care Organization. This group, in partnership with the Minnesota Department of Human Services, has been exploring the concepts of value-based purchasing and learning from the outcomes in other states. ARRM will be learning more about this organization and its work, and encourages other members to become informed as time allows (learn more about a stakeholder meeting on November 15).
This will be a long-term initiative for ARRM as it seeks to be a leading influencer on any discussion of managed care.
Continue the conversation: What questions or concerns do you have on managed care you would like to see addressed? Share in the comments below