IDD and Managed Care – How Do You Prepare?

As “Captain Obvious” has said, “There seems to be some changes coming our way”.  The problem that the Captain has ignored is we aren’t really sure what those changes will be and how they will affect our agencies and clients.

It’s been said that the potential for change in our market is there, but until contracts are signed, you really don’t know how to prepare.

With that being said, the truth is you do need to prepare.  If you don’t, you’ll find yourself falling behind in an already competitive marketplace.

When you cut through all the noise, common sense can help guide your preparation.

Invest in technology infrastructure – The move to managed care has put increasing pressure on provider organization to collect, manage, share, and analyze data for population health management and value-based contracts.  The expectation for provider organizations to offer consumer portals and monitor staff improvements will also come into play. 

As an example, the medical/hospital world has moved to this model.  It’s only logical that I/DD and Mental Health follow suit.

Technology is not just an EHR data repository.  The idea of integrating your entire agency’s back office functionality with your clinical data is the model hospitals have been using successfully for years.

Adjust revenue cycle management practice – Provider organizations must be able to provide detailed documentation of services provided, as well as accurate claims. The old fee-for-service (FFS) billing skills are of no use in a managed care environment. Preparing may mean training, it may mean outsourcing, or it may mean completely replacing your current system and staff.

The challenges to a transition to managed care are especially focused on claims and billing processing.  An integrated platform can alleviate those challenges.

Adjust organizational culture – You should realize that jobs and responsibilities within the organization may be altered or changed dramatically. Leadership should be prepared for these changes and a focused approached to staff education and preparation for change will be key to your continued success.

Invest in the future – The specifics of the future may be murky right now.  However by making the investment of preparation, your agency will be ready to prosper in the “new normal” rather than trying to catch those that have.

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