Wednesday, January 7, 2015

Over Performing, Under Paid

I recently came across a statistic that supported a theme I’ve touched on before in this blog – the fact that Colorado Community Centered Boards and service providers bring incredible value to our state. We get paid very little, yet we deliver outcomes far beyond what that payment would indicate we should be able to produce.

The stat I came across was in a chart showing the percentage, by state, of individuals with intellectual and developmental disabilities (I/DD) living in non-family settings who live with three or fewer people. That description is a mouthful, but essentially, it is a chart showing state-by-state how many people with I/DD live in large congregate settings. I think all of us can agree that the fewer people who live in these larger congregate settings, the better. That philosophy has driven services across the nation for more than 30 years. But as the chart below demonstrates, not all states in the U.S. have embraced the philosophy with equal fervor. (Note – you can click on the image below to make the chart larger, or click here for a full page view.)

Here’s the good news, at least for those of us in Colorado. Our state ranks near the top of the heap in terms of fewest people living in large group settings. This isn’t the only metric that demonstrates the skill with which providers in Colorado are able to deliver outstanding outcomes from our services. A quick perusal of The Coleman Institute for Cognitive Disabilities’ publication “The State of the States in Developmental Disabilities” shows many categories where Colorado exceeds national averages in measurements that define quality outcomes for the individuals with I/DD (important note – there is actually no such thing as a quick perusal of “The State of the States” – it is some pretty heavy reading).

Another key stat from “The State of the States” makes the accomplishments we’ve achieved in Colorado even more remarkable. According to the Coleman Institute’s research, Colorado ranks 47th in overall fiscal effort toward I/DD services. “Fiscal effort” is spending for I/DD per $1,000 of aggregate statewide personal income. In short, we come up short when directing financial resources toward the individuals we serve.

I wish I could say I’m sharing this information just to give all of us in Colorado a pat on the back. The pat is well deserved – we are poorly funded but we perform really well. Instead, I am presenting this information as a curiosity. We are in the process of redefining and redesigning how services are funded and delivered in our state. We have been down this path before, more times than I care to discuss, and most recently in 2008 when Colorado took the advisement of the Federal government to engage a fee-for-service system of payment. Everyone on the planet agrees that this was a mistake. I wonder if those involved in this process are giving the proper analysis to the current deliverables, including our state providers’ extraordinary ability to deliver in the face of limited resources. Factors that have led to those successes may be overlooked during this redesign process.

We’ve been delivering services in Colorado for more than 50 years, and Medicaid Waiver services for over 30 years We’re pretty darn good at it. System redesign is fine, and I welcome honest and open discussions as to how we can do even better. But change for change’s sake, and following the advisement from the Federal Government without a thoughtful process involving an honest look at all of the variables, isn’t likely to lead to more successful outcomes for the individuals we serve. Let’s build on our solid foundation. We already have that advantage. Ignoring this advantage comes with a great deal of risk – risk the individuals we serve can ill afford to take on.

Then again, what do I know?

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