Cars Can

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Cars Cant Snowboard Navigating the Next
Transformational Change

• Patrick M. Lanahan, J.D.
• President, Health Human Services Consulting,
  LLC
• Senior Consultant, HealthCare Perspective, LLC
• NYSACRA 12th Annual Leadership Conference
• December 5, 2014 - Saratoga Springs, New York

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Strategy, Risk, and Change

• Henry David Thoreau It is not enough to be
  busy so are the ants. The question is what
  are we busy about?

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Grasping The Reality

• Whats The Change Really about?
• Cultural, global, political, technological
• Multi-dimensional
• Historic Much, much bigger and broader than ever
  before
• Beyond the Silo Way Beyond.
• The Stakes are high for everyone
• Its about Trillions of dollars
• OPWDD waiver seeks to integrate acute and
  long-term care of 100,000 people with
  developmental disabilities
• Someday cars just might snowboard.

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Reality Elements of Change

• Person-Centered Health Care
• New York Transition to Managed Care details
• Federal/State oversight is heightened and intense
• Increasing emphasis on need for and standardized
  use of information technology and best practice
  guidelines
• Managed Care Business Model(s) Readiness
  Assessments and Transitions

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What is Managed Care really about?

• Generic, integrated business model to pursue
  value-based purchasing
• Greater predictability, less waste costs.
• Rate rationalization
• Competencies and essential business areas or
  features -- challenging for managing care on
  behalf of people receiving LTSS

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What is Managed Care really about?

• More open access to basic system-level universal
  supports, while seeking to individualize
  specialized clinical care
• Holistic approach focusing on factors which
  include lifestyle, treatment adherence, family,
  cultural and community influences
• Attention paid to the person his/her
  preferences, his/her experience in the system
• We are really going into the community now.
• Nurture relationships, collaborations, clinical
  practice guidelines, and information systems to
  support person-centered care
• Person-centered infrastructure different from
  what is done today
•  

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What is Managed Care really about?

• Features, challenges for NY providers
• Care Management/Coordination evolution
• NYs starting point is behind
• Big interests in a person-centered managed care
  design
• Getting clarity and getting moving with
  reasonable dispatch
• Perspectives of purchasers, managers, providers,
  people, families, employers, other sectors,
  communities
• Self-direction is a form of managed care
• Individualized Service Plan is a form of managed
  care

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Reality Elements of Change

• Success means managed care model must support and
  not detract from provider agency commitments and
  values
• How will day to day work operations change?
• What tools can we expect to have to be able to
  better support individuals person-centered plans?
  
• What should we be thinking about in light of the
  Federal Governments new clarity around what
  person-centered planning is?

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Reality Elements of Change

• Demographics
• New York and terminal uniqueness
• Workforce and socio-economic problems
• Systems Leaders whos up for it, whos waiting
  it out, whos out now.
• Current provider infrastructures arent built for
  this
• Things will change DURING the change!

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Reality Elements of Change

• What do the new CMS expectations for
  person-centered planning and self direction mean
  for how provider agencies must change some
  things?
• Scope of Section 2402(a) of the Affordable Care
  Act Guidance for Implementing Standards for
  person-centered planning and Self-Direction in
  Home and Community-Based Services Programs
• HCBS Final Rule LTSS provided in
  non-institutional settings
• New Yorks Olmstead Implementation and Plan
  Development

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Reality Elements of Change

• And then, theres BIP and then, theres MFP
• And then, there are DISCOs
• And there are the constraints on resources,
  tools, training, career ladders, and living wages
  acknowledged to be needed by Direct Support
  Professionals, but much higher expectations
• And then, theres NYs goal to increase Self
  Direction Enrollment from 800 to 5000
• And then, theres Employment, Housing,
  Deinstitutionalization, Rate Rationalization,
  Capitalization Requirements, Stranded Capital

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The Real Nature of the Change

• What is occurring is a deliberate effort to
  re-align policy, practice, and the plumbing
  (infrastructure) of Home and Community-Based
  Services, Medicaid, the American Health Care
  sector, and Managed Care all at the same time --
  around a person-centered set of values,
  practices, and outcomes
• But Cars Cant Snowboard. And this is about
  People.

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Great Expectations

• Follow the Money.
• Integrated electronic health information
  infrastructure in sector as a whole
• It has been written. Let it be done.
• Policy, practice, and infrastructure aligned with
  person
• Contain, manage, shift financial, clinical,
  personal outcomes risks

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Transcending the Absurd Person-Centered Managed
Care

• Implications on Arrangements with management
  entities (expect variety)
• Implications for people needing and receiving
  services and supports
• Implications for the delivery system
• Implications for the provider agency

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Dealing With the Reality Means Dealing With RISK!
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Lessons Learned from Others

• Relevant Managed Care and Self- direction
  experiences - three stories
• Readiness activities managed care and
  self-direction focused reviews and assessments
• Need to address terminal uniqueness syndrome
• Avoid political temptations and distractions
  success requires focus, expertise, a plan, and
  resources.
• Expect to build (and learn to live with)
  partnerships, changing roles of existing partners

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Lessons Learned from Others

• Lets Get Real what we know how to do today,
  tools we have, how we do it, values. Be honest.
• Lets Get Great At collaborating and changing to
  deliver what the new market will want. Be open.
• Moving Forward Need a plan and be strategic
  about how to leverage and pool resources (even in
  a very competitive and chaotic environment). Be
  Doing.
• Strong trade association advocacy and expertise
  is a critical key to success. Be learning and
  shaping.

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Questions?

• Patrick M. Lanahan, J.D.
• patrickmlanahan1_at_sbcglobal.net