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While complexity can be enjoyable at times, when we are talking about a system designed to help individuals with cognitive disabilities, I think most people would agree that convolution is not a goal to be aimed for. Oddly enough, when navigating our system of supports, I totally relate to the little dog Speck for what he is witnessing.
And so here we are again, trying to figure out how best to serve individuals in our state who have one or more developmental disabilities. And yet again, one has to wonder, are we missing the forest for the trees, and looking for complex solutions to challenges while ignoring some of the most obvious and simple answers that already exist?
So today I am presenting three simple approaches to creating a better system for serving some of our most vulnerable citizens.
- Pay for outcomes, not for units of service. When providers are paid for units of service, they no longer design their services to meet the needs of those they serve. Instead, they design their services to meet the needs of regulatory organizations. The result is a costlier system that provides fewer overall benefits. Paying for outcomes will reverse that equation and, therefore, the results.
- Find out the demand for services. We have a woefully inadequate knowledge base when it comes to how many people need services in our state, and what services are actually needed. It is time to start using the principles of Demand Management as part of a plan to provide services for individuals with cognitive and developmental disabilities here in Colorado and across the nation. But in order to do that, we need to know what the demand is in the first place.
- Look to the providers. Providers have been the ones coming up with creative and cost effective ways of providing services that have truly been revolutionary. Discover what providers are doing successfully, and look for ways to replicate those efforts across the state.
Then again, what do I know?
My one concern is with the idea of paying for outcomes, and how that might shape the way that providers approach goals. For example, Medicare will pay for post-surgery PT as long as you continue to make progress. So, it makes sense for the patient (and the provider) to progress at a snails pace to ensure that goals can continue to be set and achieved. We need to be careful that any new standards don't encourage providers to limit the growth potential of the people they serve.
ReplyDeleteMatt
ReplyDeleteI totally agree. Payment for time or units like a PT session are not what I would consider a deliverable outcome. However, I understand identifying an outcome sometimes is a challenge. Holding a job is an outcome. That is easy. Accounting for a PT session would require a baseline performance; walk 100 yards without using a walker before an incident preventing that ability, and then regaining that after treatment could be an outcome.