Inside The IDD MLTSS Workgroup
This collaboration involves recurring symposiums and published reports bringing together perspectives from 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.
Medicaid Managed Care
Medicaid managed care is a rapidly growing service delivery model in the U.S. The aim of Medicaid managed care is to reduce program costs and provide better utilization of health services through the contracting of managed care organizations (MCOs). While Medicaid managed care has existed for almost two decades, it is not frequently used for long-term services and supports (LTSS) for people with IDD.
Effect On People With IDD
As utilization of managed care for people with IDD is low, there is little research about what standards should be used for traditional as well as alternative payment models such as value-based reimbursement models. Since there is beginning to be an expansion of Medicaid managed care into the IDD LTSS system, evidenced-based quality standards and guidelines about managed care provision are critical.
IDD MLTSS Workgroup
Starting in 2018, CQL | The Council on Quality and Leadership, The Institute on Public Policy For People with Disabilities, and Mosaic organized a symposium with approximately 25 thought leaders in the healthcare and LTSS industry. Since the initial symposium, this workgroup has met a number of times to discuss quality metrics related to the expansion of Medicaid managed care into the IDD LTSS system.
CQL conducted analysis in partnership with Mosaic, a faith-based organization with agencies across the United States. Mosaic provided CQL with de-identified data about the Basic Assurances®, health metrics, and incident reports from FY 2016 to 2018, and CQL independently conducted all analyses. The pilot was comprised of data from 28 service agencies who supported a total of 2,955 people with IDD.
IDD MLTSS Reports
Through insight from the symposiums held with attendees, combined with analysis conducted in collaboration with Mosaic, CQL and workgroup sponsors have produced a series of reports to detail findings, perspectives, practical steps, and other guidance and conclusions. These reports serve to ensure that evidence-based quality measures are being used to evaluate if people are living a meaningful life.
Social Determinants of Health
Medical care is only responsible for 10-15% of preventable mortality. As a result, more emphasis should be paid to social determinants of health. CQL developed a tool to measure social determinants of health, the Social Determinants of Health Index, which was also outlined in the managed care reports. This index and its findings assisted the workgroup in understanding value-based quality measures.
Institute on Public Policy for People with Disabilities
"Compliance and quality are not the same. Compliance doesn't get you outcomes or get you paid."
"Start with outcomes and then determine the methods to get to those outcomes."
"Quality is not measuring things because they are easy to measure."
"We must have high expectations of people receiving supports, just like we do everyone else."
"The person receiving services must be in the driver's seat throughout the process."
Medicaid Managed Care: The Provider Impact
This webinar will provide an overview of Medicaid managed care, including different service delivery models and the impact on people with IDD. The webinar also highlights the perspective of human service providers and features one large agency’s experience with managed care.View The Webinar