Outcome-Driven in State Systems:
From Managed Care to Support Coordination
Over the past four years, the Office for Persons With Developmental Disabilities (OPWDD) at the State of New York has been working to shift away from traditional output-driven services to person-centered, outcome-driven supports for individuals. This shift in thinking has or will touch all aspects of the service system from managed care (MC) to support coordination. In 2013, OPWDD formalized a partnership with CQL | The Council on Quality and Leadership, to use the Personal Outcome Measures® as a conduit to a change in values in service delivery. Although OPWDD does not require the use of the Personal Outcome Measures® or CQL Accreditation for community service providers, OPWDD has embodied the importance and value of putting individualized outcomes at the core of service delivery.
In 2011, OPWDD began taking the first steps towards a transition into Managed Care for Long-Term Services and Supports (LTSS), with expectations for the first implementation plan to be completed in April 2016. The move away from traditional fee-for-service payment and delivery to managed care has required OPWDD to think through the process of monitoring, reporting on and ensuring high-quality supports. As a result, OPWDD set up a quality design team to develop a comprehensive and proactive quality monitoring and quality enhancement plan for future Managed Care Organizations (MCOs).
One of the first goals for the team involved learning about outcomes that would be meaningful, measurable and person-centered under managed care. During this discovery period, the team began researching CQL’s Personal Outcome Measures®.
Kate Bishop, Director of Health and Community Support under the Division of Person-Centered Supports for the NYS Office for People With Developmental Disabilities states “It was through learning about the CQL Personal Outcome Measures® approach that we began to develop an understanding of those Personal Outcome Measures® as one way to begin to measure the effectiveness of a person-centered plan.”
To test the utilization and value of the Personal Outcome Measures®, OPWDD engaged a group of high-preforming agencies and asked CQL to provide training to the agencies to begin using the Personal Outcome Measures®. The output from the testing led Bishop and OPWDD to formally adopt POMs in their planning process for managed care. Bishop wanted to ensure that quality monitoring in managed care not only went beyond health and welfare, but also focused on individual quality of life.
“As we are working to implement a managed care system, one of the elements that became very clear in our planning processes is, as much of the measures that have been established for individuals in a managed care environment relate to health outcomes,” states Bishop, adding “And while health outcomes are extremely important, it’s also an expectation that within the managed care system, individuals with intellectual and developmental disabilities are supported with long-term supports and services, and that those supports and services are not just about the delivery of a service, but the impact that the services has on the outcomes and the desires that are most important to the individual.”
To formalize this approach, OPWDD plans to require that MCOs collect Personal Outcome Measures® interviews as part of the quality monitoring plan and review trend analysis data using POMs to ensure service delivery aligns with what really matters to individuals.
OPWDD’s move towards the use of the Personal Outcome Measures® in managed care began what is now a strong partnership between OPWDD, CQL and community service providers across the state. After the adoption of the POMs in managed care, OPWDD was awarded grant funding from the Centers on Medicare and Medicaid (CMS) under the Balancing Incentives Program (BIP).
The BIP funding released by CMS was provided to states to develop capacity for increasing and/or improving community-based services. OPWDD was provided a large grant from CMS to make systemic changes in service delivery. Through the BIP funding, OPWDD provided the opportunity for community service providers to apply for a portion of the available funds, while keeping some funding at OPWDD.
From this, CQL has engaged with 100 agencies across the state to build infrastructure for continuing person-centered approaches in service delivery. Within agencies, CQL is providing training, accreditation and consultation. The work with individual agencies helps to ensure the system that individuals access is best situated to provide the types of services that they really want. Beyond the work with individual agencies, CQL is also working alongside OPWDD’s Division of Quality Improvement (DQI) to implement person-centered approaches and values into the State’s policy for monitoring service quality.
To accomplish this, CQL is working hand-in-hand with DQI to:
- Integrate components of the Basic Assurances® and POMs into the state’s HCBS settings transition plan
- Monitor and conducting training on POMs for state staff
- Train support coordinators on the importance of measuring and monitoring outcomes
- Provide technical assistance to DQI for stakeholder engagement and communication
- Implement additional components of systems change
The relationship between OPWDD, DQI, service providers and CQL has flourished over the past 2 years into a comprehensive, holistic, person-centered, outcomes-driven and systems change initiative.
The partnership between CQL and OPWDD is relatively young, but the work which has been conducted to-date has already had an impact within the state. Bishop states, “There are numerous success stories that occurred as a result of some changed practices around understanding and listening to the individual receiving supports and services. I think it was really that success that was achieved pretty quickly with people, which drove a desire to embrace and implement those approaches in organizations around the state.”
As this partnership moves into the future, it will be exciting to see the true impact of this large, and extremely valuable initiative.