Wednesday, February 24, 2010

Waitlist? Waitlist?

Lately I feel as if I have been channeling Jim Mora.

Who is Jim Mora, you may ask? Jim Mora was an NFL coach for several teams, but he is probably best remembered for his “playoffs?” rant. Take a look below:

I feel bad for Coach Mora that he is remembered mainly for this rant, because he was a decent coach, and because despite the apparent meltdown in the clip above, the underlying message of what he was saying was correct. A team can’t start talking about playoffs and championships until they make sure they have their fundamentals set, and know what they are supposed to be doing, and are prepared to execute the game plans.

So why do I feel like I’m channeling Jim Mora lately? Well, whenever I hear people talking about ending the waitlist for people with developmental disabilities here in Colorado I feel like saying, “What’s that? Waitlist? Waitlist? You kidding me? Don’t talk about the waitlist!”

Now, before you scream “heretic” and start throwing rotten vegetables at me, hear me out. I find it abhorrent to know that there are individuals in our great State that desperately need services and don’t have the funding to receive those services, and I am dedicated to finding solutions to ensure that everybody who needs services can access them. But the current focus in our State on the waitlist is problematic for two reasons: the waitlist data is extremely flawed, and the flawed data is increasing our collective escape avoidance behavior; you remember the old operant response that gets you away from an ongoing punishing stimulus.

Let’s look at the first issue: right now, there is no set, agreed upon number of individuals waiting for services in Colorado. According to Medicaid, an individual can’t be officially on the adult waitlist until he or she is 18 years old. But the State Division for Developmental Disabilities says the waitlist starts at 14 years old. Beyond those contradictory definitions, there is also a question of what exactly it means to be on a waitlist. If an individual is currently receiving Supported Living Services, but is on a waitlist for Comprehensive Services, is it really accurate to say that the individual is waiting for services?

Even with these confusing factors, the numbers that seem to be consistently bandied about when discussing the waitlist are usually between 10,000 to 12,000 people waiting for services. That number leads to the second problem – the (apparently) huge numbers of people who need services (punishing stimulus) scare people off from suggesting any viable solutions.

Think about it – on average, the annual cost of a Comprehensive slot in our area is around $80,000. Let’s say that half the people on the waitlist are waiting for Comprehensive slots (hey, in the absence of any real data I figure I can just throw numbers out there as good as anyone). If we use 4,000 as the number of individuals waiting for adult services as a basis, that would mean 2,000 folks are waiting for Comprehensive Services. $80,000 X 2,000 = an annual cost of $160,000,000 just to serve those individuals. Considering the current state budget crisis, no elected official is going to propose that the State should fund those services. And the emphatic defeat of Amendment 51 during the last election made it clear that Colorado voters have no desire to raise taxes to fund services.

So we find ourselves in a stalemate which won’t go away until we step back and stop using inaccurate waitlist data as our starting point.

What we do know is the number of adults receiving a service, and their relative level of need. For all kinds of practical purposes, wouldn’t it be great to know how many eligible adults are not receiving a service and their relative level of need? This would describe the total demand on the system. Then, just for fun, throw out the impractical waiver descriptions, and place this known demand on a continuum based on the relative level of need. Describe the services as an increasing continuum of care and attach a true cost of service. We have learned from previous experience that knowing a service is available when needed is often enough, and that true expenditures will stay below the budget allowance.

This demand management principle allows us to shift to new service strategies.

Until then, it is premature to talk about ending the waitlist. We need to step back first and discover what the real need is, and then ask the important questions that will provide answers that are relevant to meeting that need.

The most effective medicines treat the underlying cause of a disease, not just the symptoms we see on the outside. We need to apply the same principles in our quest to serve our communities better and more efficiently.

Then again, what do I know?

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