By Carli Friedman, CQL Director of Research
Although alternative payment models, such as Medicaid managed care, are becoming more common for Long-Term Services and Supports (LTSS) for people with intellectual and developmental disabilities (IDD), there is less research and evidence-base about standards for people with IDD. This is particularly true regarding value-based payment (VBP) models for people with IDD. Traditionally there has been a focus on the number of services provided (called fee-for-service), but VBP emphasizes the quality of the services provided – the outcomes. VBP theorizes that by emphasizing quality there will a reduction in health care costs.
As a result of the limited IDD-specific evidenced-base for VBP, as well as the fact that alternative payment models are becoming more common for people with IDD, this study conducted by CQL | The Council on Quality and Leadership examined the relationship between emergency room utilization – one of the most common VBP metrics in acute care – and quality of life outcomes. To do so, we analyzed Personal Outcome Measures® quality of life data and emergency department data from a random sample of 251 people with IDD.
According to our findings, regardless of people with IDD’s support needs (i.e., clinical ID level, dual diagnosis, daily support needed), the quality of life outcomes that most significantly reduced emergency department utilization were People Participate in the Life of the Community and People Experience Continuity and Security (see figure).
Emergency Department Visits and Outcomes
Controlling for all other variables, people who did not experience continuity and security visited the emergency department 1.19 times a year on average, while people who experienced continuity and security visited 0.40 times a year. In addition, people who did not participate in the life of the community visited the emergency department 1.19 times a year on average, while people who participated in the life of the community visited the emergency room 0.12 times a year on average.
Our findings suggest “health services alone do not equate quality LTSS for people with IDD. Instead, many other factors and social determinants impact the health and quality of life of people with IDD. As such, there must be a recognition that the whole person must be supported, and doing so can ultimately translate into financial savings, including through reduced emergency department visits” (Friedman, 2020, p. 21).
Community Participation and Continuity and Security Reduce Emergency Department Visits