A Request for Information About Managed Care


I am going to work on the development of a Care Criteria - Critical Path, or Clinical Path, or Intervention Path (for the lack of better terms at this time) for services for people with developmental disabilities. The model is the patterned from the criteria developed for acute services or mental health services. I do not want to base solely on mental diagnoses, but want to utilize a functional diagnoses. I think that I can also incorporate a point at which a stop-loss or risk pool could be implemented. What I forsee is for a functional diagnoses a series of interventions that would be expected from a contracted agency to provide. This would be fit under a capitated rate. I will have to encompass the long term care part, indidualization etc.

Do you know of any work that has already been done or any person, group or agency looking at the same thing. We also have groups working on:

  • Rate setting based on support needs and tied to the Missouri Certification Values.

  • The implementation of a capitated rate for MR/DD services.

  • The development of outcomes based on the ceritfication values.

  • Relooking at Supported Living budgets and trying to maintain the choice, individual nature but within a frameworkk of cost containment.

  • Applying some basic concepts of Managed care to a service delivery system - single stream funding, non-categorical funding.

  • I am very interested in relooking at our system of residential services and developing a non categorical system with rates based on individual support needs rather than by category, rates for groups homes, Residential Care Facilities, etc. I have reviewed the article on Support Brokerage and have talked with Michael Smull and Gary Smith about it. Any assistance or information are greatly appreciated. Please post this on your web page. Any ideas or viewpoints is appreciated.

    Robert Bauermeister (ADogbert@aol.com)
    Kansas City, Missouri





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