Managed Care: Changes, Challenges, and Choices Chris Sparks NCPC January 2019 Conference

1. Managed Care: Changes,
Challenges, and Choices
Chris Sparks

2. Important Disclaimer
 No “bad guys” here
 Community service system is
fantastically complex
 Understanding the
world view of participants.

3. What is Managed Care?

4. Global Priorities of Managed Care
1. Provider relations… How many?
2. Rate rationalization
3. Improve access and outcomes
4. Budget predictability
5. Program sustainability

5. Iowa’s Timeline
January 2015
RFP Issued
January 1, 2016
Targeted Implementation
April 1, 2016
Actual Implementation

6. The Transition to Managed Care
• Contracting challenges
• Three different MCO’s processes
• Competition for staff w/ MCO’s
• Rates set at average of 2014 level
• Increased costs to our agency
• Service authorization challenges

7. Current State of Transition
o MCOs continue to struggle to manage
within budget constraints. The system
was objectively underfunded
o Getting services right and authorized
has been a challenge
o Significant changes and challenges for
persons served
o Continued payment reform

8. Controlling Our Destiny
• Maintaining organizational equilibrium
• Provider management – be at the
table, consider partnerships
• Rate rationalization, hard to impact.
• Improve and measure quality and
outcomes
• Ensure strong legislative relations

9. To Do: Before Managed Care
• Shore up legislative/departmental
relationships
• Invest in infrastructure
• Work on quality indicators
• Identify Trending
• Seize opportunities and beyond

10. Lastly….
• Redouble your commitment, the big
“Why”
• Be flexible, creative, and innovative
• Take care of your DSPs
• The arc of change is long
• Advocate

11. Questions?
Thank You