Presentation on theme: "Preparing for Managed Care The Kansas Experience, From providers, customers and advocates Audrey Schremmer, Executive Director Three Rivers Inc., Center."— Presentation transcript:
Preparing for Managed Care The Kansas Experience, From providers, customers and advocates Audrey Schremmer, Executive Director Three Rivers Inc., Center for Independent Living
Intro to Centers for Independent Living CILs’ mission, values, and services promote community living for people with disabilities A majority of CIL staff and board must be persons with disabilities CILs provide five core services including; – information and referral – deinstitutionalization – independent living skills training – peer support – systems and individual advocacy.
KanCare KanCare, the Kansas Managed Care program rolled out January 1, 2013 KanCare was unique in its inclusion of all Medicaid populations (with only a few small exceptions) It includes individuals in long-term care and supports fee for service system. (HCBS Medicaid Waivers) It also includes an employment component The final Waiver, I/DD HCBS will come under KanCare in 2014
Why Managed Care Long-term System Reform needed Curb growth of Medicaid spending Improve quality of Medicaid services High rates of hospitalization and re- hospitalization High utilization of nursing homes despite growth in HCBS spending Poor Health outcomes
Managed Care from the Consumer’s point of View The only reason the state is interested in Managed Care is to save money… Managed Care means I’ll have more layers between me and my healthcare provider It means I’ll have to fight for my rights; I’ve seen the TV shows about people getting denied chemo and life saving procedures… Managed Care equals less care And finally, confusion, what does it really mean?
From an Provider View Reimbursement for services will reduce and/or I’ll have lengthy payment delays My paperwork just doubled Services will have to go thru lengthy approval processes, slowing down care Someone else will be second guessing every decision I make….
So where to begin as an Advocate/Provider Develop diverse partnerships with other Medicaid providers and health advocates and Medicaid enrollees Develop effective means of communication Divide and conquer, or at least divide and get really well educated Research other states who have moved to managed care in the last 3 years – talk with providers in these states, talk with participants
Request meetings with State Medicaid department early on to learn their goals and expectations Again, utilize your network to assign as many volunteers as possible to any and all State workgroups – As you get a feel for the proposed structure of the managed care system, review step by step how your current system fits in this structure; looks for changes, look for gaps
Educate Medicaid enrollees and family members and care providers thru mailings, community forums, small meetings Encourage enrollees to attend every community forum State hosts, they will be more effective than providers Develop outcome measures/quality assurance measures and forward to State staff, bring this up at every community forum Utilize your best technical partners to analyze RFP’s and to the extent possible, the contracts once they are in force.
Key areas of influence Workgroup to develop mailings to Medicaid enrollees Advocate to maintain similar processes within each MCO; care plan development, grievance processes etc. Advocate for strong Ombudsman program Insure any cost savings roll back into strengthening/expanding current programs
Post Implementation Advocacy Insure widespread representation on State oversight committees Develop methods to receive, analyze and disburse data Press for continued education of MCO staff, particularly care coordinators, if at all possible, utilize former providers for this training Maintain effective communication with MCO’s and State staff
Challenges from Administrative Perspective post implementation Contract and Credentialing System Interface Getting accustomed to new processes Employee Skill sets; managed care is very different than previous systems Unanticipated service gaps Education of consumers and family members
Challenges for Providers Post Implementation Education and support of staff Training on new technology Maintaining adequate fiscal reserves Development/purchase of new fiscal monitoring systems Consumers rely on providers to help resolve issues with their MCO’s
Challenges for Consumers, Post Implementation Lack of education about private health insurance processes Unsure about processes – move from targeted case management to MCO care coordination – who handles what?? Confusion about Client Obligation/Co-pay for services, Eligibility Supports and advocacy
Advocacy Post Implementation And finally, it ain’t over till its over! Complacency and apathy can be deadly Medicaid enrollees rarely feel empowered, advocacy training has to continue Track your data, when you help the State reach mutually important goals, (reduced hospitalization, increased access to health care) you are better positioned to advocate for system change