Investing in better case management and healthcare coordination for Arkansas’s high cost patient populations is an important step if Arkansas wants to lower overall healthcare spending. That’s according to a report presented Wednesday to the Health Care Task Force by its consultant the Stephen Group.
Managing Partner John Stephen told lawmakers Arkansas’s investment falls short.
“We looked at the other states and we found in our interviews with the Department [of Human Services] there isn’t a lot of effort put on care coordination and case management in the behavioral health and in the long term care areas,” said Stephen.
Stephen referred lawmakers to a table with information from the Centers for Medicare Services and Truven Health Analytics ranking Arkansas 40th for Medicaid State expenditures for case management for high cost patient groups. Arkansas’s average expenditure per resident was 86 cents. The national average was $8.53. Stephen bluntly told the task force,
“You don’t pay a lot for care coordination in this state. You don’t pay a lot for case management.”
“You need to make sure you look at that whole care coordination, case management idea and option. Because that’s really going to keep a lot of the population from spending a lot of time in unnecessary locations, expenditures, and doing the right quality. This is very instructive,” said Stephen.
Task force chair, and Republican Senate Majority Leader, Jim Hendren said after the Stephen Group presentation that he wants the consulting group to compile a more thorough case before he could endorse any greater investment.
“We’re spending far less on case management, managed care than a lot of other states. But we have to find out if they’re getting their bang for their buck. That’s why I asked him to do a correlation between the states that are spending a lot for managed care and what their total per member per month cost and their total growth rates, to see if it’s a worthwhile investment,” Senator Hendren said.
Stephen said a more comprehensive analysis is being researched and will be provided to lawmakers.
“Those are high cost populations and then we’re seeing a lot of that showing up in the top 1,000 utilizers. There is in our opinion, and we’ll give you more through evidence based approaches, a correlation there. We feel that way in our group strongly. It’s something we want you to focus on,” said Stephen.
The report is the second update delivered to the task force. A final report from the Stephen Group is due in October, with recommendations from the task force to come by the end of 2015. The state's version of Medicaid expansion known as the private option expires at the end of 2016.
A reliance on nursing homes is also an area warranting further study and possible changes according to Stephen’s preliminary asessments.
“There is not one mention in any of this on home based community care being a priority. It’s all about the nursing home eligibility,” said Stephen.
Paths toward utilizing community based care were broadly defined by Stephen for lawmakers.
“Transition is when you’re in the nursing home and you go back to the community. Diversion is when you are at a hospital or in a community and you are diverted from going into the nursing home by a coordination and service program that keeps you healthy in a community setting.”
While it was not mentioned by the Stephen Group or lawmakers, disability rights groups and a bi-partisan coalition of legislators have called for the Legislature to adopt language that would allow Arkansas to participate in the Community First Choice Option.
The Affordable Care Act provision, requiring state authorization, increases federal funds for disability and long-term care and allows support to flow to home based and community based settings when possible and if families prefer it to nursing homes or Human Development Centers.
