A Look at Managing Care and Care Management
Setting the Stage for Care Management
Healthcare for people with intellectual and developmental disabilities is composed of many related, but distinct components, which are frequently uncoordinated, and can be extremely difficult to access.
The lack of coordination between disciplines and services often leads to fragmented healthcare, especially for people with intellectual and developmental disabilities.
According to the National Council on Disability (2013), managed care “involves efforts to coordinate, organize, and rationalize the delivery of health care services and supports in a manner designed to improve service access and quality while avoiding unnecessary expenditures” (National Council on Disability, 2013).
The Office for People with Developmental Disabilities (OPWDD) is responsible for coordinating services for more than 130,000 New Yorkers with developmental disabilities, including intellectual disabilities, cerebral palsy, down syndrome, autism spectrum disorders, and other neurological impairments.
Care management has been in place for complex medical, behavioral health, and substance abuse populations, but not for individuals in OPWDD.
What’s to Come?
OPWDD will be taking on the Health Home model which will “provide the strong and stable person-centered approach to holistic service planning and coordination required to ensure delivery of quality care” (Opwdd.ny.gov, 2018).
This will involve the creation of Care Coordination Organizations (CCOs) which are essentially health homes.
CCOs will involve a specialized team, comprised of a care manager and other professionals, that will work with people with IDD and their families to plan, execute and monitor individualized Life Plans. The goal will be to better coordinate healthcare, wellness, and Developmental Disabilities services.
Transition to Managed Care Timeline
- June 30, 2017: Draft I/DD Health Home Application Released
- August 4, 2017 – Due date extended to August 11, 2017: Due date to submit comments on the draft of Health Home Application to Serve Individuals with I/DD
- August 4, 2017: Due date to submit a letter of interest
- October 6, 2017: Final Health Home Application to Serve Individuals with I/DD released
- November 30, 2017: Due date to submit Health Home Application to Service Individuals with I/DD
- December 1, 2017 - February 28, 2018: Review and approval of Health Home Application to Serve Individuals with I/DD by the State
- March 1, 2018 - June 30, 2018: Health Home and Network Partner Readiness Activities
- Through June 30, 2018: State webinars, training, and other readiness activities
- July 2018: Transition to CCO/HH Care Management for Individuals with I/DD
National Council on Disability. (2013). An Overview of Medicaid Managed Care. Retrieved from https://ncd.gov/publications/2013/20130315/20130315_Ch1
Opwdd.ny.gov. (2018). What is a Care Coordination Organization / Health Home (CCO/HH)? | OPWDD. [online] Available at: https://opwdd.ny.gov/node/13836