Whole Person Care For I/DD? Find A Partner

By Monica E. Oss, Chief Executive Officer, OPEN MINDS

Consumers with intellectual/developmental disabilities (I/DD) are a focus of both policy makers and health plan executives. For policy makers, there is a focus on improving life expectancy. For this population, life expectancy is 20 years shorter than that of the general population—and these consumers are three times as likely to die following a COVID-19 diagnosis. And, 70% to 80% of this population has multiple physical medical and behavioral co-morbidities. For health plan executives, the focus is on the cost of health care services.

These statistics are driving a focus on whole person care models, with integrated care coordination and care delivery, for consumers with I/DD. The question for the executive teams of provider organizations serving these consumers is how to create a workable model. That was the focus of The 2022 OPEN MINDS I/DD Executive Summit session, Designing A Service Delivery System For Consumers With I/DD & Complex Medical Needs, featuring Karen Lindgren, Ph.D., Chief Clinical Officer at Bancroft and Upward Health’s Mark Treat, Chief Strategy Officer and Anubhav Kaul, M.D., Senior Vice President – Medical Affairs.

Bancroft, a $200 million non-profit provider organization serving children and adults with autism and I/DD, partnered with Senacare to deliver their integrated care model. The partnership started with a pilot site serving 100 consumers with complex needs—consumers using 170 emergency room visits, 40 urgent care visits, and 212 primary care visits in a year.

Upward Health is an in-home multidisciplinary provider organization. They created a partnership with Seven Hills Foundation to provide a full range of in-home services (medical and behavioral) for Seven Hills residential programs in Massachusetts.

Their advice—learn how to create great partnerships in order to delivery a full range of services. That includes building shared goals and performance metrics from the outset, creating a framework for data-based decision making, and building a financial model that aligns with both partners.

Build concrete partnership goals and performance metrics from the outset—Building a strategic partnership often means operating outside your strengths. And doing that will rely on creating a relationship with an organization that can complement your organization’s skillset or strengthen what you are already doing. The key is both finding the “right” partner and agreeing on a list of shared goals and expected levels of performance.

“We finally identified a partner to get higher quality and better outcomes,” Dr. Lindgren said. “Their primary goals were access and communication. Our primary problems were access and communication. We knew there was an opportunity when we looked at what they did in terms of care coordination and meeting people where they are at. We knew we had the building blocks to make a partnership. They brought with them expertise in population health and value-based reimbursement, which was where our knowledge gaps were.”

Create a framework for data-based decisionmaking between the partners—Partnerships are challenging in the best of circumstances. A key to shared decision making is to monitor progress toward the shared performance metrics—and use those performance metrics to guide program management.

“One of the things we needed to do was develop data systems,” Dr. Lindgren said. “But data systems are more than collecting data. It’s also working with employees so they understand why accurate data and timely data is really valuable. We had to work with our employees so that they understood we were all driving down the road to change outcomes. We had to do a lot of work on the culture, processes, and data systems. The data systems are so critical in helping everyone know where you are going. We’ve built data dashboards, so everyone sees everyone’s data on the same dashboard. That really sends a message that this is the goal.”

Build a financial model that is aligned for both partners—For partnerships to succeed in the long run, the financial incentives for both partners need to be in synch. For many provider organizations, there will be a lot on the line when investing in a new strategy for this high-cost and high-risk population. But success, particularly financial success, needs to be aligned for both partners. This means that the service model must support itself financially and both partners are delivering on the requirements needed to make the model work.

“You must decide early on what you will invest in both in effort and time to make these models work,” Dr. Lindgren explained. “It was not success on the first try for us. First, we brought medical care in, internally, but we were not skilled at documenting, billing, collecting, or any of the systems around medical care. Second, we tried an on-site director, but we didn’t align ourselves from a quality perspective, so we had all the same barriers. We then tried pure telehealth, but the employees kept reaching out to internal nurses and didn’t adopt to telehealth.”

As the ‘value chain’ in the health and human service field evolves, executive teams of most specialty provider organizations are going to have to make a decision about the integrated care issue and their relationship to primary care systems. The options are limited—to develop referral relationships and interoperable data integration with primary care provider organizations; to create primary care delivery capacity; or to create partnerships with primary care provider organizations. Each option has its challenges. But for executive teams choosing the partnership option, focusing on alignment in objectives, decision making, and financial incentives are key.