Wednesday, February 13, 2019

Where Are Your Champions?

Misheard lyrics from popular songs have been a source of entertainment for years. You can find many YouTube videos dedicated to this very topic.
Recently I had my own version of a misheard lyric. It wasn’t technically a misheard lyric, but rather, my brain filled in an incorrect lyric when I was listening to a song while thinking about the State of Colorado’s system of funding and delivering services to individuals with intellectual and developmental disabilities (I/DD).

The song? "We Are The Champions" by Queen. My misheard lyric? “Where are the champions?”

Now, of course I know the real lyrics. But as I was listening, I was thinking about a revelation I had come to recently: why doesn’t Colorado consider itself a champion of people with I/DD? Of course, Colorado supports those individuals, but is it possible the State champions a different master? Specifically, the Federal government and Medicaid?

That’s perfectly understandable. The Centers for Medicare and Medicaid (CMS) are essentially the customer, telling the State what to do and how to do it with their Medicaid dollars. So of course, the State looks to its customer in order to determine if it is doing a good job delivering customer service. 

And guess what? By CMS standards, Colorado probably is doing a good job. The State is focused on homogenizing and cutting costs at the behest of CMS and has made nice work of it. The State is the champion of Medicaid. That is not the same as being a champion of people living with I/DD in Colorado funded by Medicaid, or any other group of Medicaid beneficiaries.

Here’s a comparison. Think about a hypothetical athletic director at a major university; similar to an Executive Director of a State Department. That person should select and hire champions of each sport at the university; coaches who are experts in their event, who in turn select student athletes who are good performers in their event.

Why? That is what the fans and supporters want; the best coaching staff and players of each individual sport, be it swimming, track and field, or football.

What you wouldn’t do is hire a champion of uniforms to cost effectively outfit all of the teams with the same uniform because it would save money. It doesn’t matter that the swim team was wearing a football jersey when they dive in the pool. It matters that the champion homogenized the uniforms to cut costs. Or imagine a champion of balls; insuring there are adequate game balls, but not necessarily assigned to the appropriate game. Why? The champion isn’t and expert on the game – just that the balls are inflated properly.

While the AD needs to respond to and pay attention to his or her budget, and to NCAA rules and regulations, that shouldn’t be the primary drivers for champion roles. Winning more games draws more attention and revenue, the desired outcomes. Wearing the same uniform in all events will not accomplish the same, any more than a football on a golf tee. I think the results would be average athletics at best.

The AD wouldn’t be looking for the best coaches or players, they would be looking for the most affordable transactions in the athletic department. They wouldn’t be stretching the limits of the teams and what they could do, they’d be limiting their ability to stretch. They wouldn’t be trying to make teams stand out, they would want them to all look and play the same. The school’s athletic teams would regress to the middle at best, and the bottom at worst, because the desired outcome in sports – performance – wouldn’t be part of the policy making process. Have you seen the trends reported by the 2019 UCP Case For Inclusion?

In our State, I wonder if, by successfully being a champion of Medicaid, have we have lost the winning performance we once knew? Rather than being a champion of people and selecting performers in specific fields of expertise, we have homogenized transactions and outfitted providers with uniforms that say, “Go Medicaid!” and players with I/DD blended on teams of people with a variety of other health care needs.

I’d argue (and have argued before) that for providers, what I think should be our version of winning – positive outcomes for those we serve – isn’t a big part of our State’s policy making process. State providers are like the coaches and players for the hypothetical college mentioned above that makes all of its decisions based on budgetary and regulatory concerns.

(Cue the music) We are Champions of Medicaid; promoting cost cutting and homogenization. Again, have you seen the 2019 UCP Case for Inclusion? We don’t have an I/DD champion, and our team needs one.

(Cue the music again) Where are their champions?

Then again, what do I know?

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