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Managed Care & Persons with Disabilities & Chronic Illnesses

Summary of Workshop for Senior State Officials


This workshop offered State and local policymakers information about the performance of managed care plans in meeting the needs of persons with disabilities and about what design features are associated with sucessful programs for persons with disabilities and chronic illnesses. It was held in Chandler, Arizona, November 5-7, 1997.

About the Workshop Sponsor.


Overview

Across the United States, the number of people enrolled in managed care plans continues to grow. As part of this overall growth of managed care coverage, an increasing number of people with disabilities and chronic illnesses are also being enrolled into such arrangements.

This is perhaps most clearly visible with respect to State Medicaid programs' managed care initiatives. Early State efforts to enroll Medicaid recipients typically focused on the Aid to Families with Dependent Children (AFDC)-related populations comprised of mothers and their children. More recently, a number of States have moved or are moving into what might be considered the second phase of their Medicaid managed care initiatives, in which they are seeking to enroll their Supplemental Security Income (SSI)-related populations into managed care.

Despite this trend, very little information exists about the performance of managed care plans in meeting the needs of persons with disabilities or about what might be the design features associated with successful programs. Indeed, the factors that must be considered and addressed for managed care to be responsive to the needs of these individuals are significant. They include:

  • The segment of the population with disabilities and chronic illnesses is, in fact, a very heterogeneous group with diverse health problems, service needs, and preferences that may differ from the general population.
  • These populations have historically encountered problems in receiving needed care. Successful programs must ensure that financial incentives associated with capitated payment arrangements do not exacerbate these problems but instead promote innovative and efficient approaches to meeting these individuals' needs.
  • The medical needs of many people with disabilities and chronic illnesses are often closely tied to their needs for other less medically oriented supportive services. However, many managed care plans have very little experience in addressing the unique medical needs of these persons, let alone this extended set of needs.
  • Indicators developed to measure the performance of managed care plans in meeting the needs of the general population may not be appropriate for assessing how well they meet the needs of persons with disabilities and chronic illnesses.
  • The requirements of many of the programs that finance care for these populations, including differences between Medicaid and Medicare that affect the dually eligible population, compound the difficulty of coordinating or integrating care at the service delivery level.

Objectives

Many State officials, as well as other public and private sector policymakers, are seeking ways to address these issues as they design, implement, and monitor the performance of managed care programs serving persons with disabilities and chronic illnesses. The Agency for Health Care Policy and Research, through its User Liaison Program, designed this workshop in an effort to provide them with information to assist them in responding to these challenges.

The objectives of the workshop were:

  • To provide participants with information about the size, characteristics, and needs and preferences of the populations of people with disabilities or chronic conditions that will be important for policymakers to consider in designing managed care policies or initiatives.
  • To identify key managed care program design considerations that are likely to influence the success of the program in meeting the needs of these vulnerable populations and to discuss the implications of the Americans with Disabilities Act and other Federal statutes dealing with discrimination for the design and operation of managed care plans.
  • To share the experiences of selected States covering Medicaid recipients with disabilities and chronic conditions under managed care arrangements.
  • To discuss strategies that States are pursuing in their efforts to ensure that Medicaid managed care plans are appropriately meeting the needs of enrollees with disabilities and chronic illnesses and issues associated with the collection and dissemination of information about consumer satisfaction with different plans to this population.

Although the issues associated with meeting and coordinating the acute and long-term care needs of persons with disabilities were raised at the workshop, long-term care issues were not a primary focus of this workshop.

Participants

The participants for this workshop were senior State and local officials from both the executive and legislative branches of government with responsibility for the design, implementation, and evaluation of health care programs serving people with disabilities or chronic illnesses, including State Medicaid officials involved in the design of managed care programs for these populations.

Workshop Sessions

 

The User Liaison Program (ULP) disseminates health services research findings in easily understandable and usable formats through interactive workshops. Workshops and other support are planned to meet the needs of Federal, State, and local policymakers, and other health services research users, such as purchasers, administrators, and health plans.

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